Individual
JOHN E. TITAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3 FAIRFIELD DR, AVONDALE ESTATES, GA 30002-1421
(678) 432-3144
(678) 432-3420
Mailing address
3 FAIRFIELD DR, AVONDALE ESTATES, GA 30002-1421
(678) 432-3144
(678) 432-3420
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
001466
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000743597N
—
GA
Enumeration date
03/22/2006
Last updated
03/31/2015
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