IndividualActive
Benjamin Idiale, LDO
NPI 1417484510 · Optician · Stone Mountain, GA
Provider details
- NPI number
- 1417484510
- Entity type
- Individual
- Primary specialty
- OpticianEye and Vision Services Providers
- Credential
- LDO
- Sex
- Male
- Sole proprietor
- No
- License
- LDO002703 (GA)
Specialties & taxonomies
Eye and Vision Services Providers
Practice location
5226 Stone Mountain Hwy Ste B
Stone Mountain, GA 30087-3455
Phone: (404) 578-9117
Approximate (ZIP-level) locationGet directions
Mailing address
5226 Stone Mountain Hwy Ste B
Stone Mountain, GA 30087-3455
Registry dates
- Enumerated
- 2017-05-19
- Last updated
- 2022-07-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.