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General NPI Number Information
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NPI Number | 1215925078
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Entity Type | Individual
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Provider Name | ADEKUNLE EMMANUEL OLUWADARE OD MSC
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Gender | Male
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 1342 AUBURN RD
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City | DACULA
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State | GA
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Zip | 30019-1674
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Country | US
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Telephone | 770-237-8150
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Fax | 678-889-9546
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Provider Business Mailing Address
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Address Line | 3592 HUDDLESTONE LN
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City | BUFORD
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State | GA
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Zip | 30519-4652
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Country | US
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Telephone | 610-800-1125
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OEG001715
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | GA2345
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License Number State | GA
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