Provider Demographics
NPI:1265737274
Name:MS OPTICS BUFORD LLC
Entity type:Organization
Organization Name:MS OPTICS BUFORD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-730-2363
Mailing Address - Street 1:3264 BUFORD DR
Mailing Address - Street 2:SUITE100A
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-8764
Mailing Address - Country:US
Mailing Address - Phone:678-730-2363
Mailing Address - Fax:678-730-2367
Practice Address - Street 1:3264 BUFORD DR
Practice Address - Street 2:SUITE100A
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-8764
Practice Address - Country:US
Practice Address - Phone:678-730-2363
Practice Address - Fax:678-730-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
GA001964156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty