Healthcare Provider Details

I. General information

NPI: 1811483928
Provider Name (Legal Business Name): OLIVIA OYEGUNLE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 DUNWOODY CLUB DR STE 126
SANDY SPRINGS GA
30350-5436
US

IV. Provider business mailing address

2090 DUNWOODY CLUB DR STE 126
SANDY SPRINGS GA
30350-5436
US

V. Phone/Fax

Practice location:
  • Phone: 770-676-7848
  • Fax: 470-246-4876
Mailing address:
  • Phone: 770-676-7848
  • Fax: 470-246-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003092
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: