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General NPI Number Information
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NPI Number | 1023463528
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Entity Type | Organization
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Legal Business Name | EMINENCE FAMILY EYECARE, LLC
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 05/03/2016
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Provider Practice Location Address
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Address Line | 6300 ATLANTA HWY # 9 SUITE 101A
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City | ALPHARETTA
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State | GA
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Zip | 30004-7821
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Country | US
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Telephone | 678-825-4077
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 ATLANTA HWY # 9 SUITE 101A
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City | ALPHARETTA
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State | GA
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Zip | 30004-7821
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Country | US
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Telephone | 678-825-4077
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | DR. STELLA ONYEKWELU
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Credential | O.D
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Telephone | 678-825-4077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPT002814
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | OPT002814
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | OPT002814
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002814
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License Number State | GA
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