Provider Demographics
NPI:1154054138
Name:SIDDIQUE, AYSHA (OD)
Entity Type:Individual
Prefix:DR
First Name:AYSHA
Middle Name:
Last Name:SIDDIQUE
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 1:1781 CLAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4005
Mailing Address - Country:US
Mailing Address - Phone:404-471-9990
Mailing Address - Fax:404-471-9910
Practice Address - Street 1:1781 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4005
Practice Address - Country:US
Practice Address - Phone:404-471-9990
Practice Address - Fax:404-471-9910
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003434152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist