Individual
DR. MUMTAZ F BASHIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2014 LAWRENCEVILLE SUWANEE RD, SUWANEE, GA 30024-2625
(678) 649-2020
(678) 331-5117
Mailing address
2964 SILVERMERE LANE, DULUTH, GA 30097
(678) 439-1393
(678) 331-5117
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1909
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000919982B
—
GA
Enumeration date
10/04/2006
Last updated
10/12/2021
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