Provider Demographics
NPI:1952470072
Name:ATLANTA EYE PROSTHETICS INCORPORATED
Entity Type:Organization
Organization Name:ATLANTA EYE PROSTHETICS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:ALCORTA
Authorized Official - Suffix:I
Authorized Official - Credentials:BCO
Authorized Official - Phone:559-940-1189
Mailing Address - Street 1:6065 ROSWELL RD STE 870
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4065
Mailing Address - Country:US
Mailing Address - Phone:404-352-4550
Mailing Address - Fax:404-352-5833
Practice Address - Street 1:6065 ROSWELL RD STE 870
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4065
Practice Address - Country:US
Practice Address - Phone:404-352-4550
Practice Address - Fax:404-352-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA119660-8332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000411166AMedicaid
GA0758420001OtherMEDICARE SUPPLIER BILLING NUMBER