Organization Active NPI

Stephen Rothbloom OD, LLC

  • Optometrist
  • Smyrna, GA
National Provider Identifier
1619124583
Registry record updated May 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
GA 1090 Issued in GA
Legal business name
STEPHEN ROTHBLOOM OD, LLC
Practice address
1655 Spring Rd SE
Smyrna, GA 30080-3774
Phone
(678) 842-9544
Fax
(678) 842-9291
NPI assigned
Aug 22, 2008
Last updated
May 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2026

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

Authorized official

Name
Dr. Stephen Rothbloom, ODNPI 1780686048
Title
Owner
Phone
(678) 842-9544

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
Optometrist 152W00000X GA 1090 GA Primary

Addresses

Primary practice location

1655 Spring Rd SE
Smyrna, GA 30080-3774

Mailing address

1655 Spring Rd SE
Smyrna, GA 30080-3774
Phone (678) 842-9544

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081025000098 GA Part B Supplier - Clinic/Group Practice 6103984752 Receives reassigned benefits from 2 practitioners
Practice locations: Smyrna, GA

National Provider Directory

National Provider Directory

Locations

1655 Spring Rd SE
Smyrna, GA 30080
Phone (678) 842-9544

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778544000000",
    "number": "1619124583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1655 SPRING RD SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300803774",
            "telephone_number": "678-842-9544",
            "fax_number": "678-842-9291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 SPRING RD SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300803774",
            "telephone_number": "678-842-9544",
            "fax_number": "678-842-9291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN ROTHBLOOM OD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-22",
        "last_updated": "2026-05-12",
        "certification_date": "2026-05-12",
        "status": "A",
        "authorized_official_last_name": "ROTHBLOOM",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-842-9544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "GA 1090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smyrna, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2026; 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.