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General NPI Number Information
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NPI Number | 1578188306
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Entity Type | Organization
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Legal Business Name | THE EYE MD
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 1359 MILSTEAD ROAD SUITE #103
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City | CONYERS
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State | GA
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Zip | 30012
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Country | US
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Telephone | 678-509-3639
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Fax |
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Provider Business Mailing Address
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Address Line | 1359 MILSTEAD RD NE STE 103
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City | CONYERS
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State | GA
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Zip | 30012-3865
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Country | US
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Telephone | 770-691-5176
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Fax |
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | MEJA RAQUEL DAY
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Credential | MD
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Telephone | 770-691-5176
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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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