Provider Demographics
NPI:1124281217
Name:RADU, IONUT (OD)
Entity type:Individual
Prefix:DR
First Name:IONUT
Middle Name:
Last Name:RADU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3774 CONRAIL CIR
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-1341
Mailing Address - Country:US
Mailing Address - Phone:662-342-1543
Mailing Address - Fax:
Practice Address - Street 1:3839 MUNDY MILLS ROAD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566
Practice Address - Country:US
Practice Address - Phone:770-532-5110
Practice Address - Fax:770-532-5152
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist