Provider Demographics
NPI:1891886263
Name:SHARA DRAPER, O.D., LLC
Entity Type:Organization
Organization Name:SHARA DRAPER, O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-422-9092
Mailing Address - Street 1:3837 WESTWICK WAY
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152
Mailing Address - Country:US
Mailing Address - Phone:770-422-9092
Mailing Address - Fax:770-529-7789
Practice Address - Street 1:3837 WESTWICK WAY
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152
Practice Address - Country:US
Practice Address - Phone:770-422-9092
Practice Address - Fax:770-529-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41ZCFZXMedicare ID - Type Unspecified
GAU43731Medicare UPIN