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General NPI Number Information
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NPI Number | 1588265177
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Entity Type | Individual
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Provider Name | DUSHIKA RAVENDRARAJAH OD
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Gender | Female
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 10550 S CICERO AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-5597
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Country | US
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Telephone | 708-499-3911
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Fax |
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Provider Business Mailing Address
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Address Line | 6700 DOUGLAS BLVD STE 1270
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1590
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Country | US
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Telephone | 770-942-9827
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Fax | 770-577-2384
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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 | OPT003297
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License Number State | GA
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