Basic Information
| Provider Information | |||||||||
| NPI: | 1427590314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESCOBAR | ||||||||
| FirstName: | ADRIANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 SPRINGHURST BLVD | ||||||||
| Address2: | SUITE NUMBER 103 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402416137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024234444 | ||||||||
| FaxNumber: | 5024234477 | ||||||||
| Practice Location | |||||||||
| Address1: | 324 NEWNAN CROSSING BYP | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302651082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784233927 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2016 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT002986 | GA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.