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General NPI Number Information
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NPI Number | 1083042253
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Entity Type | Organization
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Legal Business Name | NORTHSIDE EYE PARTNERS, PC
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 2230 ROSWELL RD SUITE 100
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City | MARIETTA
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State | GA
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Zip | 30062-2939
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Country | US
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Telephone | 678-903-2579
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Fax | 678-903-2583
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Provider Business Mailing Address
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Address Line | 2230 ROSWELL RD SUITE 100
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City | MARIETTA
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State | GA
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Zip | 30062-2939
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Country | US
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Telephone | 678-903-2579
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Fax | 678-903-2583
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL SUJI
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Credential | O.D.
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Telephone | 678-903-2579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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