Provider Demographics
NPI:1821248980
Name:DR. ROOZBEH YAZDANI OD PC
Entity Type:Organization
Organization Name:DR. ROOZBEH YAZDANI OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOZBEH
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-778-2152
Mailing Address - Street 1:665 JEFFERSON PL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6453
Mailing Address - Country:US
Mailing Address - Phone:706-778-2152
Mailing Address - Fax:706-894-1227
Practice Address - Street 1:308 HABERSHAM HILLS CIR
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-5388
Practice Address - Country:US
Practice Address - Phone:706-778-2152
Practice Address - Fax:706-894-1227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty