NPI 1457767253 · live from the CMS NPI Registry
Derrick Badaracco
Optometrist in Buford, GA. National Provider Identifier 1457767253, active.
NPI record
| NPI | 1457767253 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 3290 Buford Dr, Suite B-2, Buford, GA 30519 |
| Practice phone | 724-799-1387 |
| Mailing address | 4180 Butler Dr, Chamblee, GA 30341 |
| Enumerated | July 1, 2014 |
| Last updated | October 16, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist | 152W00000X | 0618002352 (VA) |
| Optometrist primary | 152W00000X | GA 2860 (GA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.