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General NPI Number Information
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NPI Number | 1598928913
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Entity Type | Organization
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Legal Business Name | EYE ON PEACHTREE INC.
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 1544 PIEDMONT AVE NE SUITE 320
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City | ATLANTA
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State | GA
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Zip | 30324-5018
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Country | US
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Telephone | 404-888-9444
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Fax | 404-888-9666
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Provider Business Mailing Address
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Address Line | 1544 PIEDMONT AVE NE SUITE 320
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City | ATLANTA
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State | GA
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Zip | 30324-5018
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Country | US
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Telephone | 404-888-9444
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Fax | 404-888-9666
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REENA CHOPRA GUPTA
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Credential | O.D.
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Telephone | 404-580-8458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OPT002285
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License Number State | GA
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