Provider Demographics
NPI:1386164465
Name:JAKUPOVIC, ALDINA (OD)
Entity type:Individual
Prefix:
First Name:ALDINA
Middle Name:
Last Name:JAKUPOVIC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 WYTOWER TRL
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-4159
Mailing Address - Country:US
Mailing Address - Phone:470-262-8571
Mailing Address - Fax:
Practice Address - Street 1:901 ABERNATHY RD STE 100
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-2561
Practice Address - Country:US
Practice Address - Phone:404-252-1702
Practice Address - Fax:404-303-8843
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist