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NPI Code Detail

MEDICARE: CANDACE HINES KOTEI O.D.

MEDICARE:   CANDACE HINES KOTEI  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPT002774GA

General Provider Information

NPI Number : 1639511223
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE HINES KOTEI O.D.
Provider Business Mailing Address
First Line : 180 JACKSON ST NE
Second Line : APT 6115
City : ATLANTA
State : GA
Zip : 30312-1303
Country : US
Telephone Number : 260-241-5617
Fax Number :
Provider Business Practice Location Address
First Line : 4280 E WEST CONNECTOR SE
Second Line :
City : SMYRNA
State : GA
Zip : 30082-4804
Country : US
Telephone Number : 770-435-4457
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2013
Last Update Date : 07/23/2013

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Directions to “ CANDACE HINES KOTEI O.D.” Practice Location

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