Provider Demographics
NPI:1073796389
Name:AKSTEIN EYE CENTER
Entity Type:Organization
Organization Name:AKSTEIN EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:BRASILIANO
Authorized Official - Last Name:AKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-996-4844
Mailing Address - Street 1:86 UPPER RIVERDALE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:770-996-4844
Mailing Address - Fax:770-907-0884
Practice Address - Street 1:86 UPPER RIVERDALE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:770-996-4844
Practice Address - Fax:770-907-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018778207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000216532BMedicaid
GA000216532BMedicaid
GAGRP925Medicare PIN
GA216820390BMedicare PIN