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General NPI Number Information
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NPI Number | 1811134596
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Entity Type | Organization
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Legal Business Name | DR. AMIR BORHANIPOOR OD
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 4004 LAWRENCEVILLE HWY NW
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City | LILBURN
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State | GA
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Zip | 30047-2820
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Country | US
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Telephone | 770-717-9455
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Fax | 770-717-9416
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Provider Business Mailing Address
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Address Line | 4004 LAWRENCEVILLE HWY NW
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City | LILBURN
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State | GA
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Zip | 30047-2820
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Country | US
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Telephone | 770-717-9455
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Fax | 770-717-9416
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMIR BORHANIPOOR
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Credential | OD
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Telephone | 770-717-9455
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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 | 1871
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License Number State | GA
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