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General NPI Number Information
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NPI Number | 1295579381
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Entity Type | Organization
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Legal Business Name | CARROLLTON OPTICS LLC
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Dates
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Enumeration Date | 06/24/2024
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 1313 S PARK ST
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City | CARROLLTON
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State | GA
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Zip | 30117-4433
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Country | US
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Telephone | 770-832-1457
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 S PARK ST
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City | CARROLLTON
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State | GA
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Zip | 30117-4433
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. FAREED DOSANI
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Credential | OD
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Telephone | 770-655-0989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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