Provider Demographics
NPI:1639265267
Name:YAZDANI, ROOZBEH (OPTOMETRIST)
Entity Type:Individual
Prefix:
First Name:ROOZBEH
Middle Name:
Last Name:YAZDANI
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 FURNITURE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-5388
Mailing Address - Country:US
Mailing Address - Phone:706-778-2152
Mailing Address - Fax:706-894-1227
Practice Address - Street 1:250 FURNITURE DR
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531
Practice Address - Country:US
Practice Address - Phone:706-778-2152
Practice Address - Fax:706-894-1227
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 1706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist