Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT003060 | GA |
NPI | 1003171349 |
---|---|
Provider Name | Dr. Neville Kersi Dalal |
First Address | Atlanta, GA 30309-3749 |
Second Address | Woodstock, GA 30188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 26/01/2021 |