Provider Demographics
NPI:1053061747
Name:GWINNETT OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:GWINNETT OPHTHALMOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:UME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-233-8441
Mailing Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5032
Mailing Address - Country:US
Mailing Address - Phone:678-585-1901
Mailing Address - Fax:678-691-2138
Practice Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5032
Practice Address - Country:US
Practice Address - Phone:678-585-1901
Practice Address - Fax:678-691-2138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty