Individual provider Active NPI

Godwin Ilegbedion Ekekhomen, OD

  • Optometrist
  • Snellville, GA
National Provider Identifier
1235340415
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT002372 Issued in GA
Practice address
2205 Oakland Spring Dr
Snellville, GA 30039-7956
Phone
(404) 735-9513
Fax
(770) 498-3440
NPI assigned
May 27, 2007
Sex
Male
Sole proprietor
Yes

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 OPT002372 GA Primary

Addresses

Primary practice location

2205 Oakland Spring Dr
Snellville, GA 30039-7956

Mailing address

2205 Oakland Spring Dr
Snellville, GA 30039-7956
Phone (404) 735-9513

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
I20080221000402 GA Practitioner - Optometry 6305920877 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT002372GAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Lynn O.D. & Associates, PC CurrentSince Mar 11, 2015 Accepting new patients
Mark Lynn OD & Associates, PC Optometrist CurrentSince Mar 11, 2015 Accepting new patients
Ga Doctors of Optometry LLC Optometrist CurrentSince Oct 17, 2021 Accepting new patients
Ga Doctors of Optometry LLC Optometrist CurrentSince Oct 17, 2021 Accepting new patients

Locations

50 Main Street Market Pl SE
Ste 100
Cartersville, GA 30121
Phone (770) 382-6379

4373 Jimmy Lee Smith Pkwy
Ste 101
Hiram, GA 30141
Phone (770) 943-2220

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

Organizations & group practices 4

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": "1180224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235340415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 OAKLAND SPRING DR",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300397956",
            "telephone_number": "404-735-9513",
            "fax_number": "770-498-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 OAKLAND SPRING DR",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300397956",
            "telephone_number": "404-735-9513",
            "fax_number": "770-498-3440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EKEKHOMEN",
        "first_name": "GODWIN",
        "middle_name": "ILEGBEDION",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

Verify at the official NPI Registry.