Provider Demographics
NPI:1386846293
Name:UNSWORTH, LOAN VO (OD)
Entity Type:Individual
Prefix:DR
First Name:LOAN
Middle Name:VO
Last Name:UNSWORTH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1788 SCOUTS WALK
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7817
Mailing Address - Country:US
Mailing Address - Phone:770-380-3501
Mailing Address - Fax:
Practice Address - Street 1:3130 MATHIS AIRPORT PKWY STE 308
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9132
Practice Address - Country:US
Practice Address - Phone:770-574-6090
Practice Address - Fax:770-574-6099
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist