Provider Demographics
NPI:1255602538
Name:DR. RANAN B. STIMPSON OD PC
Entity type:Organization
Organization Name:DR. RANAN B. STIMPSON OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:STIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-422-2021
Mailing Address - Street 1:3700 LARGENT WAY NW
Mailing Address - Street 2:STE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1670
Mailing Address - Country:US
Mailing Address - Phone:770-422-2021
Mailing Address - Fax:770-514-9603
Practice Address - Street 1:3700 LARGENT WAY NW
Practice Address - Street 2:STE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1670
Practice Address - Country:US
Practice Address - Phone:770-422-2021
Practice Address - Fax:770-514-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001294T261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU25496Medicare UPIN