Provider Demographics
NPI:1598988719
Name:LITTLE FIVE POINTS EYE CARE, INC.
Entity Type:Organization
Organization Name:LITTLE FIVE POINTS EYE CARE, INC.
Other - Org Name:EYE ETC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:STAMBOLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-523-3937
Mailing Address - Street 1:484 MORELAND AVE NE STE D
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-3421
Mailing Address - Country:US
Mailing Address - Phone:404-523-3937
Mailing Address - Fax:404-688-3232
Practice Address - Street 1:484 MORELAND AVE NE STE D
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-3421
Practice Address - Country:US
Practice Address - Phone:404-523-3937
Practice Address - Fax:404-688-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU13457Medicare UPIN
GA41ZCFCVMedicare ID - Type Unspecified