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General NPI Number Information
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NPI Number | 1942518774
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Entity Type | Individual
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Provider Name | IVANA OBRADOVIC O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 2460 INDIA HOOK RD STE 206
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City | ROCK HILL
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State | SC
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Zip | 29732-3578
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Country | US
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Telephone | 803-985-2020
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Fax | 803-985-2021
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Provider Business Mailing Address
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Address Line | 3176 S UNIVERSITY DR
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City | MIRAMAR
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State | FL
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Zip | 33025-3002
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Country | US
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Telephone | 954-431-2020
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Fax | 954-435-7124
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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 | 2256
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 4521
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License Number State | FL
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