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General NPI Number Information
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NPI Number | 1063391407
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Entity Type | Organization
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Legal Business Name | EYE ON GENETICS
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 3516 WOODHAVEN RD NW
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City | ATLANTA
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State | GA
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Zip | 30305-1011
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Country | US
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Telephone | 404-431-5929
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Fax |
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Provider Business Mailing Address
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Address Line | 3516 WOODHAVEN RD NW
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City | ATLANTA
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State | GA
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Zip | 30305-1011
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Country | US
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Telephone | 404-431-5929
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/CEO
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Name | JESSICA MCCLUSKEY
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Credential | MD
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Telephone | 404-431-5929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number |
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License Number State |
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