Provider Demographics
NPI:1447809066
Name:OLAKUNLE ADEGBILE & ASSOCIATES PROFESSIONAL CORP
Entity type:Organization
Organization Name:OLAKUNLE ADEGBILE & ASSOCIATES PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAKUNLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADEGBILE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-961-1968
Mailing Address - Street 1:5471 NORMAN CT
Mailing Address - Street 2:BLDG 9250
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30349
Mailing Address - Country:US
Mailing Address - Phone:770-961-1968
Mailing Address - Fax:
Practice Address - Street 1:1500 SOUTHLAKE MALL
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2330
Practice Address - Country:US
Practice Address - Phone:937-304-7633
Practice Address - Fax:770-961-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty