Healthcare Provider Details

I. General information

NPI: 1699109025
Provider Name (Legal Business Name): RIMA MACWAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIMA THAKKER

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 LOWER ROSWELL RD STE 20-40
MARIETTA GA
30068-4375
US

IV. Provider business mailing address

4880 LOWER ROSWELL RD STE 20-40
MARIETTA GA
30068-4375
US

V. Phone/Fax

Practice location:
  • Phone: 609-649-4202
  • Fax:
Mailing address:
  • Phone: 609-649-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003411
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: