Romanda Basaly Demetrios
Optometrist
12924 Highway 92
Woodstock
, Georgia 30188-5192
Romanda Basaly Demetrios
Optometrist
12924 Highway 92
Woodstock
, Georgia 30188-5192
(404) 932-2802
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About
Features
Specialties
- Optometrist
Languages spoken
- English
Location
First Address
- Romanda Basaly Demetrios
- 1568 Sherwood Ct
- Dearborn, MI
- Zip : 48124-4016
- Phone : (404) 932-2802
Second Address
- Romanda Basaly Demetrios
- 12924 Highway 92
- Woodstock, GA
- Zip : 30188-5192
- Fax : (770) 926-2287
- Phone : (678) 717-9121
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 152W00000X | Optometrist | 4901004806 | MI |
| Y | 152W00000X | Optometrist | OPT002962 | GA |
National Provider Identifier
| NPI | 1003243502 |
|---|---|
| Provider Name | Romanda Basaly Demetrios |
| First Address | Dearborn, MI 48124-4016 |
| Second Address | Woodstock, GA 30188-5192 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 30/09/2013 |
| Last Update Date | 15/02/2018 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.