| Stone Mountain Eye Center | |
|
1525 E Park Place Blvd Ste 1800 Stone Mountain GA 30087-6403 | |
| (770) 498-3434 | |
| (770) 498-3440 |
| Full Name | Stone Mountain Eye Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1525 E Park Place Blvd Ste 1800, Stone Mountain, Georgia |
| Authorized Official Name and Position | Elizabeth Sobanjo (PRESIDENT) |
| Authorized Official Contact | 7704983434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stone Mountain Eye Center 1525 E Park Place Blvd Ste 1800 Stone Mountain GA 30087-6403 Ph: (770) 498-3434 | Stone Mountain Eye Center 1525 E Park Place Blvd Ste 1800 Stone Mountain GA 30087-6403 Ph: (770) 498-3434 |
| NPI Number | 1528228616 |
|---|---|
| Provider Enumeration Date | 06/11/2008 |
| Last Update Date | 04/28/2016 |
| Medicare PECOS PAC ID | 1850524182 |
|---|---|
| Medicare Enrollment ID | O20140512001312 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528228616 | NPI | - | NPPES |
| 0009004134 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1538 (Georgia) | Primary |
| Provider Name | Elizabeth Sobanjo |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1548313851 PECOS PAC ID: 7719169101 Enrollment ID: I20110307000243 |
| Provider Name | Kofi Oteng Gyang |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1144373267 PECOS PAC ID: 6800053919 Enrollment ID: I20120201000391 |
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