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General NPI Number Information
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NPI Number | 1629701818
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Entity Type | Individual
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Provider Name | CYNTHIA ROSE ENTREKIN OD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 921 MOORES FERRY RD STE C
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City | VILLA RICA
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State | GA
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Zip | 30180-9706
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Country | US
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Telephone | 678-460-0498
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Fax |
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Provider Business Mailing Address
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Address Line | 501 VALLEY RUN DR
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City | BREMEN
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State | GA
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Zip | 30110-2411
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Country | US
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Telephone | 770-630-4932
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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 | OPT003429
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License Number State | GA
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