Provider Demographics
NPI:1396791935
Name:HORAK, IVO (OD)
Entity type:Individual
Prefix:DR
First Name:IVO
Middle Name:
Last Name:HORAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1750 POWDER SPRINGS RD SW STE 210
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4848
Mailing Address - Country:US
Mailing Address - Phone:770-436-9123
Mailing Address - Fax:770-436-9193
Practice Address - Street 1:47 GRAMLING ST SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-2517
Practice Address - Country:US
Practice Address - Phone:770-436-9123
Practice Address - Fax:770-436-9193
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA267216858AMedicaid
GA267216858BMedicaid
GA41ZCFLKMedicare Oscar/Certification