Provider Demographics
NPI:1538309851
Name:BELVEDERE EYE CENTER, INC.
Entity Type:Organization
Organization Name:BELVEDERE EYE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:GINSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:770-380-0346
Mailing Address - Street 1:1424 DALEWOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3408
Mailing Address - Country:US
Mailing Address - Phone:770-380-0346
Mailing Address - Fax:404-534-1242
Practice Address - Street 1:3479 MEMORIAL DR
Practice Address - Street 2:EXHIBIT A&B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2735
Practice Address - Country:US
Practice Address - Phone:404-534-1222
Practice Address - Fax:404-534-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1143T152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000384282DMedicaid