Provider Demographics
NPI:1518373646
Name:LAKHANI, RAKESHKUMAR (OD)
Entity Type:Individual
Prefix:DR
First Name:RAKESHKUMAR
Middle Name:
Last Name:LAKHANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 ROSWELL RD STE 1430
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8191
Mailing Address - Country:US
Mailing Address - Phone:770-509-9932
Mailing Address - Fax:770-509-2612
Practice Address - Street 1:4475 ROSWELL RD STE 1430
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8191
Practice Address - Country:US
Practice Address - Phone:770-509-9932
Practice Address - Fax:770-509-2612
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002824152W00000X
TX8815T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist