NPIMap

Organization Active NPI

Southeast Eye Surgery Center, PC

Doing business as Omni Eye Services

  • Ophthalmology Physician
  • Atlanta, GA
National Provider Identifier
1629120928
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SOUTHEAST EYE SURGERY CENTER, PC
Doing business as
Omni Eye Services
Practice address
5505 Peachtree Dunwoody Rd NE
Suite 300
Atlanta, GA 30342-1705
Phone
(404) 257-0814
Fax
(404) 843-8521
NPI assigned
Jan 17, 2007
Last updated
Dec 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Authorized official

Name
Jennifer Boyd Baldock
Title
Officer and Authorized Official
Phone
(615) 234-5954

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

5505 Peachtree Dunwoody Rd NE
Suite 300
Atlanta, GA 30342-1705

Mailing address

5505 Peachtree Dunwoody Rd NE
Suite 300
Atlanta, GA 30342-1705
Phone (404) 257-0814

Other names 1

  • Omni Eye Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031222000062 GA Part B Supplier - Clinic/Group Practice 0345148979 Receives reassigned benefits from 7 practitioners
Practice locations: Atlanta, GA; Conyers, GA; Carrollton, GA

National Provider Directory

National Provider Directory

Locations

1903 Phoenix Blvd
Ste 100
Atlanta, GA 30349
Phone (770) 996-6664

3200 Downwood Cir NW
Ste 200
Atlanta, GA 30327
Phone (404) 351-1990

805 Dixie St
Carrollton, GA 30117
Phone (770) 214-3569

1800 Phoenix Blvd
Ste 406
College Park, GA 30349
Phone (770) 996-6664

1504 Chattanooga Rd
Dalton, GA 30720
Phone (706) 279-1551

3800 Pleasant Hill Rd
Ste 1
Duluth, GA 30096
Phone (678) 473-9755

3030 Lafayette Rd
Ft Oglethorpe, GA 30742
Phone (706) 861-5915

5505 Ptree Dunwoody Rd NE
Ste 300
Sandy Springs, GA 30342
Phone (404) 355-8721

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1629120928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5505 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421705",
            "telephone_number": "404-257-0814",
            "fax_number": "404-843-8521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 PEACHTREE DUNWOODY RD NE",
            "address_2": "SUITE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421705",
            "telephone_number": "404-257-0814",
            "fax_number": "404-843-8521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST EYE SURGERY CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5954"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omni Eye Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Omni Eye Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 9, 2022; 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.