Provider Demographics
NPI:1972038933
Name:GAZAL EYECARE
Entity Type:Organization
Organization Name:GAZAL EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ALDINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKUPOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:470-729-2020
Mailing Address - Street 1:76 NORCROSS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3866
Mailing Address - Country:US
Mailing Address - Phone:470-729-2020
Mailing Address - Fax:
Practice Address - Street 1:76 NORCROSS ST
Practice Address - Street 2:SUITE B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3866
Practice Address - Country:US
Practice Address - Phone:470-729-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty