Provider Demographics
NPI:1720270879
Name:AKSTEIN EYE CENTER, ASC
Entity Type:Organization
Organization Name:AKSTEIN EYE CENTER, ASC
Other - Org Name:AKSTEIN EYE CENTER, ASC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
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 SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2622
Mailing Address - Country:US
Mailing Address - Phone:770-996-4844
Mailing Address - Fax:770-907-0884
Practice Address - Street 1:86 UPPER RIVERDALE RD SW
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2622
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:2007-08-13
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111172ASCAOtherMEDICARE PROVIDER NUMBER
GA000880745AMedicaid