Provider Demographics
NPI:1952093106
Name:AHMED, HANAN (DISPENSING OPTICIAN)
Entity Type:Individual
Prefix:
First Name:HANAN
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:DISPENSING OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 ROCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3335
Mailing Address - Country:US
Mailing Address - Phone:770-469-3221
Mailing Address - Fax:
Practice Address - Street 1:514 TYNE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-1545
Practice Address - Country:US
Practice Address - Phone:678-591-9755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002290156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician