NPIMap

Organization Active NPI

Song Badaracco Eyecare LLC

  • Optometrist
  • Atlanta, GA
National Provider Identifier
1376020495
Registry record updated Jul 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT002861 Issued in GA
Legal business name
SONG BADARACCO EYECARE LLC
Practice address
870 Inman Village Pkwy NE Ste 3
Atlanta, GA 30307-5523
Phone
(404) 589-0822
Fax
(404) 589-4766
NPI assigned
Jul 21, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2018

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

Authorized official

Name
Jennifer S Badaracco, ODNPI 1689080996
Title
Owner/OD
Phone
(215) 688-7425

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPT002861 GA Primary

Addresses

Primary practice location

870 Inman Village Pkwy NE Ste 3
Atlanta, GA 30307-5523

Mailing address

8415 Moor Park Run
Duluth, GA 30097-1695

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1532131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532131200000",
    "number": "1376020495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8415 MOOR PARK RUN",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300971695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 INMAN VILLAGE PKWY NE STE 3",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303075523",
            "telephone_number": "404-589-0822",
            "fax_number": "404-589-4766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SONG BADARACCO EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-21",
        "last_updated": "2018-07-21",
        "status": "A",
        "authorized_official_last_name": "BADARACCO",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/OD",
        "authorized_official_telephone_number": "215-688-7425",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.