Provider Demographics
NPI:1326083494
Name:IVO HORAK OD PC
Entity Type:Organization
Organization Name:IVO HORAK OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:IVO
Authorized Official - Middle Name:
Authorized Official - Last Name:HORAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-436-9123
Mailing Address - Street 1:1750 POWDER SPRINGS RD SW STE 210
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4848
Mailing Address - Country:US
Mailing Address - Phone:770-436-9123
Mailing Address - Fax:770-436-9193
Practice Address - Street 1:1750 POWDER SPRINGS RD SW STE 210
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4848
Practice Address - Country:US
Practice Address - Phone:770-436-9123
Practice Address - Fax:770-436-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA267216858AMedicaid
GAU97465Medicare UPIN
GA41ZCFLKMedicare Oscar/Certification