Provider Demographics
NPI:1790811909
Name:DOSANI, MALIK (LDO)
Entity Type:Individual
Prefix:MR
First Name:MALIK
Middle Name:
Last Name:DOSANI
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 SCENIC HWY N
Mailing Address - Street 2:SUITE K-L
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2134
Mailing Address - Country:US
Mailing Address - Phone:770-736-3006
Mailing Address - Fax:678-344-7222
Practice Address - Street 1:1708 SCENIC HWY N
Practice Address - Street 2:SUITE K-L
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2134
Practice Address - Country:US
Practice Address - Phone:770-736-3006
Practice Address - Fax:678-344-7222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1964156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA1964OtherEYEMED