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General NPI Number Information
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NPI Number | 1336191899
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Entity Type | Individual
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Provider Name | LOPA SHETH O.D
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Gender | Female
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 503 FURYS FERRY RD
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City | MARTINEZ
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State | GA
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Zip | 30907-9059
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Country | US
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Telephone | 706-860-8899
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Fax | 706-863-7822
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Provider Business Mailing Address
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Address Line | 1950 OLD GALLOWS RD SUITE 520
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City | VIENNA
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State | VA
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Zip | 22182-3990
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Country | US
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Telephone | 703-847-8899
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Fax | 703-991-0514
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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 | OPT001520
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License Number State | GA
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