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General NPI Number Information
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NPI Number | 1437712080
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Entity Type | Individual
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Provider Name | RONNIE MAK OD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 06/28/2025
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Provider Practice Location Address
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Address Line | 11030 MEDLOCK BRIDGE RD STE 140
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City | JOHNS CREEK
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State | GA
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Zip | 30097-3503
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Country | US
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Telephone | 678-388-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 690 ROSEBURY LN
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City | SUWANEE
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State | GA
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Zip | 30024-6816
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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 |
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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 | OPT003150
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License Number State | GA
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