Healthcare Provider Details

I. General information

NPI: 1669390597
Provider Name (Legal Business Name): STONE MOUNTAIN EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 W PARK PLACE BLVD
STONE MOUNTAIN GA
30087
US

IV. Provider business mailing address

1915 W PARK PLACE BLVD
STONE MOUNTAIN GA
30087
US

V. Phone/Fax

Practice location:
  • Phone: 678-748-3925
  • Fax: 678-748-3926
Mailing address:
  • Phone: 678-748-3925
  • Fax: 678-748-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: HAEMI CHOI
Title or Position: OWNER
Credential:
Phone: 404-992-1828