Provider Demographics
NPI:1932443470
Name:ADEGBILE, OLAKUNLE
Entity type:Individual
Prefix:DR
First Name:OLAKUNLE
Middle Name:
Last Name:ADEGBILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 NORMAN CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-6974
Mailing Address - Country:US
Mailing Address - Phone:937-304-7633
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:770-961-1968
Practice Address - Fax:770-961-9307
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist