Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | NCLE 052983 | GA |
N | 156FX1100X | Ophthalmic | ABO 21662 | GA |
N | 156FX1800X | Optician | LDO 002105 | GA |
NPI | 1093844862 |
---|---|
Provider Name | Mr. Victor O Akande |
First Address | Stone Mountain, GA 30086-0717 |
Second Address | Decatur, GA 30032-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |