Provider Demographics
NPI:1952370876
Name:ODION, GEGE (OD)
Entity Type:Individual
Prefix:DR
First Name:GEGE
Middle Name:
Last Name:ODION
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 RIVERSOUND DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8540
Mailing Address - Country:US
Mailing Address - Phone:404-244-8787
Mailing Address - Fax:404-241-2248
Practice Address - Street 1:2801 CANDLER RD
Practice Address - Street 2:SUITE 66
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1427
Practice Address - Country:US
Practice Address - Phone:404-244-8787
Practice Address - Fax:404-241-2248
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1912188996OtherGROUP NPI
GA1952370876OtherINDIVIDUAL NPI
GA000727086AMedicaid
GA41ZCCNJMedicare PIN
GA1952370876OtherINDIVIDUAL NPI
GAU41356Medicare UPIN