Healthcare Provider Details

I. General information

NPI: 1861302911
Provider Name (Legal Business Name): LAKESHIA MAE KAUFFMAN ABOC, NCLEC, LDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4469 WASHINGTON RD
EVANS GA
30809-3807
US

IV. Provider business mailing address

2056 SUMMERTON CIR
EVANS GA
30809-6702
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-7779
  • Fax: 706-854-7668
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number002905
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: