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General NPI Number Information
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NPI Number | 1174515464
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Entity Type | Organization
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Legal Business Name | DR. MAURICE E. ZADEH, OPTOMETRIST, P.C.
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 910 HOLCOMB BRIDGE RD SUITE 100
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City | ROSWELL
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State | GA
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Zip | 30076-1981
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Country | US
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Telephone | 770-992-6789
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Fax | 770-640-6789
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Provider Business Mailing Address
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Address Line | 910 HOLCOMB BRIDGE RD STE 100
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City | ROSWELL
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State | GA
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Zip | 30076-1981
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Country | US
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Telephone | 770-992-6789
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Fax | 770-640-6789
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAURICE E. ZADEH
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Credential | O.D.
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Telephone | 770-992-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | GA001234
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License Number State | GA
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