Provider Demographics
NPI:1457546376
Name:PAYNE, MALIQUE ROXANNE (OD)
Entity type:Individual
Prefix:MRS
First Name:MALIQUE
Middle Name:ROXANNE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:125 PAVILION PKWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4098
Mailing Address - Country:US
Mailing Address - Phone:770-460-7894
Mailing Address - Fax:770-719-4392
Practice Address - Street 1:125 PAVILION PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4098
Practice Address - Country:US
Practice Address - Phone:770-460-7894
Practice Address - Fax:770-719-4392
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR-227-TA-984152W00000X
NYTUV007182152W00000X
GAOPT002483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist