Healthcare Provider Details

I. General information

NPI: 1861671174
Provider Name (Legal Business Name): NORMA ANGELICA ZUNIGA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3393 PEACHTREE RD NE SUITE B128
ATLANTA GA
30326-1162
US

IV. Provider business mailing address

3071 WOODWALK DR SE
ATLANTA GA
30339-8551
US

V. Phone/Fax

Practice location:
  • Phone: 404-233-9296
  • Fax: 404-841-9908
Mailing address:
  • Phone: 404-861-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002392
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: