Provider Demographics
NPI:1427590314
Name:ESCOBAR, ADRIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:
Last Name:ESCOBAR
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 1:3801 SPRINGHURST BLVD
Mailing Address - Street 2:SUITE NUMBER 103
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6137
Mailing Address - Country:US
Mailing Address - Phone:502-423-4444
Mailing Address - Fax:502-423-4477
Practice Address - Street 1:324 NEWNAN CROSSING BYP
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1082
Practice Address - Country:US
Practice Address - Phone:678-423-3927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002986152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist