Individual provider Active NPI

Agnes Adu, OD

  • Optometrist
  • Sugar Hill, GA
National Provider Identifier
1013034453
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
001522 Issued in GA
Practice address
373 Westwater RDG
Sugar Hill, GA 30518-5697
Phone
(770) 598-7512
NPI assigned
Mar 22, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 001522 GA Primary

Addresses

Primary practice location

373 Westwater RDG
Sugar Hill, GA 30518-5697

Mailing address

373 Westwater RDG
Sugar Hill, GA 30518-5697
Phone (770) 598-7512

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20130321000113 GA Practitioner - Optometry 3072758127 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
001522GAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Lynn OD & Associates, PC Optometrist Current Accepting new patients

Locations

2929 Turner Hill Rd
Ste 2625
Lithonia, GA 30038
Phone (770) 482-5050

1905 Scenic Hwy N
Ste 1130
Snellville, GA 30078
Phone (678) 344-9954

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013034453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "373 WESTWATER RDG",
            "city": "SUGAR HILL",
            "state": "GA",
            "postal_code": "305185697",
            "telephone_number": "770-598-7512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "373 WESTWATER RDG",
            "city": "SUGAR HILL",
            "state": "GA",
            "postal_code": "305185697",
            "telephone_number": "770-598-7512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADU",
        "first_name": "AGNES",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "001522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sugar Hill, GA

Sources for this page

Verify at the official NPI Registry.