Healthcare Provider Details

I. General information

NPI: 1700774122
Provider Name (Legal Business Name): VAISHNAVI T NARAIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SOUTHPOINT BLVD
MCDONOUGH GA
30253-7320
US

IV. Provider business mailing address

PO BOX 187
KATHLEEN GA
31047-0187
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-2020
  • Fax:
Mailing address:
  • Phone: 478-988-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003692
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: