Provider Demographics
NPI:1629701818
Name:ENTREKIN, CYNTHIA ROSE (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ROSE
Last Name:ENTREKIN
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 1:501 VALLEY RUN DR
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-2411
Mailing Address - Country:US
Mailing Address - Phone:770-630-4932
Mailing Address - Fax:
Practice Address - Street 1:921 MOORES FERRY RD STE C
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-9706
Practice Address - Country:US
Practice Address - Phone:678-460-0498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003429152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist