Provider Demographics
NPI:1023463528
Name:EMINENCE FAMILY EYECARE, LLC
Entity type:Organization
Organization Name:EMINENCE FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEKWELU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-825-4077
Mailing Address - Street 1:6300 ATLANTA HWY # 9
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7821
Mailing Address - Country:US
Mailing Address - Phone:678-825-4077
Mailing Address - Fax:
Practice Address - Street 1:6300 ATLANTA HWY # 9
Practice Address - Street 2:SUITE 101A
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-7821
Practice Address - Country:US
Practice Address - Phone:678-825-4077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002814152WC0802X, 152WP0200X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty