Stone Mountain Eye Center

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

1538 Issued in GA

Legal business name

STONE MOUNTAIN EYE CENTER

Practice address

1525 E Park Place Blvd Ste 1800
Stone Mountain, GA 30087-6403

Phone

(770) 498-3434

Fax

(770) 498-3440

NPI assigned

Jun 11, 2008

Last updated

Apr 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Elizabeth Sobanjo, O.DNPI 1548313851

Title

President

Phone

(770) 498-3434

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elizabeth Imade Sobanjo, O.D

  • Optometrist
  • Stone Mountain, GA
  • NPI 1548313851
  Medicare reassignment NPD Authorized official
• Kofi Oteng Gyang, O.D

  • Optometrist
  • Stone Mountain, GA
  • NPI 1144373267
  Medicare reassignment NPD

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461801600000",
    "number": "1528228616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 E PARK PLACE BLVD STE 1800",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876403",
            "telephone_number": "770-498-3434",
            "fax_number": "770-498-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E PARK PLACE BLVD STE 1800",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876403",
            "telephone_number": "770-498-3434",
            "fax_number": "770-498-3440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONE MOUNTAIN EYE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-11",
        "last_updated": "2016-04-28",
        "status": "A",
        "authorized_official_last_name": "SOBANJO",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-498-3434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "1538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009004134",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stone Mountain
• Stone Mountain Christian Counseling Services Inc
• Stone Mountain Dental
• Stone Mountain Dental PC
• Stone Mountain Dialysis Center, LLC (Fresenius Medical Care Stone Mountain)
• Stone Mountain Eyecare LLC
• Stone Mountain Family Medicine PC
• Stone Mountain Family Practice, PC
• Stone Mountain Immediate Medical Care, Inc.
• Stone Mountain Run of Journey LLC

• Clinic/Center in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.