Provider Demographics
NPI:1528080710
Name:LASALLE, EMILY ROSE (OD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ROSE
Last Name:LASALLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:732 CRESCENT CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-4771
Mailing Address - Country:US
Mailing Address - Phone:614-638-3140
Mailing Address - Fax:
Practice Address - Street 1:1810 CUMMING HWY SPC F-1010
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-2986
Practice Address - Country:US
Practice Address - Phone:770-704-9666
Practice Address - Fax:614-856-0534
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5621152W00000X
GA003225152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist