NPIMap

Organization Active NPI

Mobile Medical Eye Care LLC

  • Optometrist
  • Stockbridge, GA
National Provider Identifier
1629680830
Registry record updated Aug 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MOBILE MEDICAL EYE CARE LLC
Practice address
110 Moseley Crossing Dr
Stockbridge, GA 30281-6501
Phone
(502) 244-2420
Fax
(502) 996-8282
NPI assigned
Aug 19, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2020

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

Authorized official

Name
Dedrick Ahmed, OD
Title
Owner
Phone
(469) 660-4503

Specialties & licenses 1

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

Addresses

Primary practice location

110 Moseley Crossing Dr
Stockbridge, GA 30281-6501

Mailing address

12910 Shelbyville Rd Ste 300
Louisville, KY 40243-2404
Phone (502) 244-2420

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200828001372 GA Part B Supplier - Clinic/Group Practice 6800213380 Receives reassigned benefits from 15 practitioners
Practice locations: Stockbridge, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597795200000",
    "number": "1629680830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12910 SHELBYVILLE RD STE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402432404",
            "telephone_number": "502-244-2420",
            "fax_number": "502-996-8282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MOSELEY CROSSING DR",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816501",
            "telephone_number": "502-244-2420",
            "fax_number": "502-996-8282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE MEDICAL EYE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "DEDRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-660-4503",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.