MEDICARE: BELVEDERE EYE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WP0200X	Pediatric Optometrist	1143T	GA
2	152W00000X	Optometrist	1143T	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538309851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELVEDERE EYE CENTER, INC.

Provider Business Mailing Address
First Line	:	2891 N DECATUR RD STE F
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-7426
Country	:	US
Telephone Number	:	770-380-0346
Fax Number	:	404-534-1242

Provider Business Practice Location Address
First Line	:	2891 N DECATUR RD STE F
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-7426
Country	:	US
Telephone Number	:	404-534-1222
Fax Number	:	404-534-1242

Authorized Official
Title or Position	:	TREASURER
Name	:	HOWARD I GINSBURG
Credential	:	CPA
Telephone Number	:	770-380-0346

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	04/14/2026

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