Provider Demographics
NPI:1811134596
Name:DR. AMIR BORHANIPOOR OD
Entity type:Organization
Organization Name:DR. AMIR BORHANIPOOR OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BORHANIPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-717-9455
Mailing Address - Street 1:4004 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2820
Mailing Address - Country:US
Mailing Address - Phone:770-717-9455
Mailing Address - Fax:770-717-9416
Practice Address - Street 1:4004 LAWRENCEVILLE HWY NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2820
Practice Address - Country:US
Practice Address - Phone:770-717-9455
Practice Address - Fax:770-717-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty