MEDICARE: PEACH OPTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2240	GA

General Provider Information

NPI Number	:	1174757090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACH OPTICS

Provider Business Mailing Address
First Line	:	2900 PEACHTREE RD NW
Second Line	:	SUITE#301
City	:	ATLANTA
State	:	GA
Zip	:	30305-4915
Country	:	US
Telephone Number	:	404-869-5551
Fax Number	:	404-869-5181

Provider Business Practice Location Address
First Line	:	2900 PEACHTREE RD NW
Second Line	:	SUITE#301
City	:	ATLANTA
State	:	GA
Zip	:	30305-4915
Country	:	US
Telephone Number	:	404-869-5551
Fax Number	:	404-869-5181

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. TERESA I HSU
Credential	:	O.D.
Telephone Number	:	404-869-5551

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	05/06/2009

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