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General NPI Number Information
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NPI Number | 1821248980
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Entity Type | Organization
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Legal Business Name | DR. ROOZBEH YAZDANI OD PC
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 308 HABERSHAM HILLS CIR
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City | CORNELIA
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State | GA
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Zip | 30531-5388
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Country | US
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Telephone | 706-778-2152
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Fax | 706-894-1227
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Provider Business Mailing Address
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Address Line | 665 JEFFERSON PL
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City | CUMMING
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State | GA
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Zip | 30040-6453
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Country | US
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Telephone | 706-778-2152
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Fax | 706-894-1227
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. ROOZBEH YAZDANI
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Credential | OD
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Telephone | 706-778-2152
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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 | GA1706
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License Number State | GA
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