Healthcare Provider Details

I. General information

NPI: 1952673527
Provider Name (Legal Business Name): JANNA IYER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11735 POINTE PL
ROSWELL GA
30076-4636
US

IV. Provider business mailing address

11735 POINTE PL
ROSWELL GA
30076-4636
US

V. Phone/Fax

Practice location:
  • Phone: 678-256-3990
  • Fax:
Mailing address:
  • Phone: 678-256-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOPT002678
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2678
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2997
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: