Provider Demographics
NPI:1053689588
Name:AMIN, BOSKI ROHITKUMAR (OD)
Entity Type:Individual
Prefix:MRS
First Name:BOSKI
Middle Name:ROHITKUMAR
Last Name:AMIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4574 LAWRENCEVILLE HWY NW STE 201
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3605
Mailing Address - Country:US
Mailing Address - Phone:770-381-6706
Mailing Address - Fax:770-921-7653
Practice Address - Street 1:4574 LAWRENCEVILLE HWY NW STE 201
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3605
Practice Address - Country:US
Practice Address - Phone:770-381-6706
Practice Address - Fax:770-921-7653
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002655152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist