Individual provider Active NPI

Abdul Babajide Daranijoh, O.D

  • Optometrist
  • Augusta, GA
National Provider Identifier
1013000744
Registry record updated Dec 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
002274 Issued in GA
Practice address
3412 Wrightsboro Rd
Suite 905
Augusta, GA 30909-2500
Phone
(706) 736-3937
Fax
(706) 736-3938
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 5, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 002274 GA Primary
Optometrist 152W00000X 1489 SC

Addresses

Primary practice location

3412 Wrightsboro Rd
Suite 905
Augusta, GA 30909-2500

Mailing address

P.O.Box 3151
Evans, GA 30809
Phone (812) 219-3207

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110725000023 SC Practitioner - Optometry 3779751433 Reassigns benefits to 1 organization
I20110726000237 GA Practitioner - Optometry 3779751433 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2005
Medicare assignment
May accept Medicare assignment
Group practices
Martinez Eye Associates LLCGroup PAC ID 2860660529, 4 clinicians

Practice addresses (Care Compare)

201 Harbison Blvd
Suite 110
Columbia, SC 29212-2270
Phone (803) 732-1942

3412 Wrightsboro Rd
Suite 905
Augusta, GA 30909-1015
Phone (706) 736-3937

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002274GAMDOptometrist
1489SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Martinez Eye Associates LLC Optometrist CurrentSince Dec 12, 2005 Accepting new patients

Locations

3412 Wrightsboro Rd
Ste 905
Augusta, GA 30909
Phone (706) 736-3937

10136 Two Notch Rd
Ste 107D
Columbia, SC 29229
Phone (803) 477-3109

201 Harbison Blvd
Ste 110
Columbia, SC 29212
Phone (803) 732-1917

Networks

  • devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1
  • devoted network organization-0f7f8d4f-1035-4992-8c02-dc86d12e700e
  • FL HMO
  • FL HMO D-SNP
  • FL HMO C-SNP

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417737600000",
    "number": "1013000744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O.BOX 3151",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "30809",
            "telephone_number": "812-219-3207",
            "fax_number": "866-687-8165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3412 WRIGHTSBORO RD",
            "address_2": "SUITE 905",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309092500",
            "telephone_number": "706-736-3937",
            "fax_number": "706-736-3938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DARANIJOH",
        "first_name": "ABDUL",
        "middle_name": "BABAJIDE",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2014-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "002274",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1489",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.