Individual provider Active NPI

Yewande Olateju Alonge, O.D

  • Optometrist
  • Raleigh, NC
National Provider Identifier
1245580984
Registry record updated Aug 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2296 Issued in NC
Practice address
6212 Glenwood Ave Ste 101
Raleigh, NC 27612-2657
Phone
(919) 781-4266
NPI assigned
Sep 10, 2012
Last updated
Aug 2, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X 2296 NC
Low Vision Rehabilitation Optometrist 152WL0500X 2296 NC
Pediatric Optometrist 152WP0200X 2296 NC
Optometrist 152W00000X 2296 NC Primary

Addresses

Primary practice location

6212 Glenwood Ave Ste 101
Raleigh, NC 27612-2657

Mailing address

6212 Glenwood Ave
Raleigh, NC 27612-0049
Phone (919) 781-4266

Other names 1

  • Dr. Yewande Olateju Olagoke Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, MN2 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
I20121218000429 NC Practitioner - Optometry 8820247646
I20160926000012 MN Practitioner - Optometry 8820247646 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2296NCMDPediatric Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Minnesota Optical LLC Optometrist CurrentSince Aug 21, 2016 Accepting new patients
Minnesota Optical LLC CurrentSince Aug 21, 2016 Accepting new patients
New Century Ophthalmology, PC Past Accepting new patients
America's Best Contacts & Eyeglasses PastSince Aug 6, 2019 Accepting new patients

Locations

19576 Holt St NW
Elk River, MN 55330
Phone (763) 241-2083

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, 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": "1347235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564704000000",
    "number": "1245580984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6212 GLENWOOD AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276120049",
            "telephone_number": "919-781-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6212 GLENWOOD AVE STE 101",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276122657",
            "telephone_number": "919-781-4266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALONGE",
        "first_name": "YEWANDE",
        "middle_name": "OLATEJU",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-10",
        "last_updated": "2019-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NC",
            "license": "2296",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "NC",
            "license": "2296",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "NC",
            "license": "2296",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "YEWANDE",
            "last_name": "OLAGOKE",
            "middle_name": "OLATEJU",
            "prefix": "DR.",
            "credential": "O.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.