Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT002360 | GA |
NPI | 1003030156 |
---|---|
Provider Name | Dr. Mohamed Eid |
First Address | Norcross, GA 30092-4611 |
Second Address | Norcross, GA 30092-4611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 28/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U96268 | (02) | IL |
U96268 | (02) | MI |