Provider Demographics
NPI:1306366828
Name:HROZENCIK, ILANA GINSBURG (OD)
Entity Type:Individual
Prefix:DR
First Name:ILANA
Middle Name:GINSBURG
Last Name:HROZENCIK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ILANA
Other - Middle Name:
Other - Last Name:GINSBURG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3479 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE A AND B
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032
Mailing Address - Country:US
Mailing Address - Phone:404-534-1222
Mailing Address - Fax:404-534-1242
Practice Address - Street 1:3479 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2735
Practice Address - Country:US
Practice Address - Phone:404-558-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty