MEDICARE: DR. PETER J MORESI OD

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	OPT1083	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	204999784	OTHER	GA	TAX ID

General Provider Information

NPI Number	:	1386747640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER J MORESI OD

Provider Business Mailing Address
First Line	:	1950 OLD GALLOWS RD
Second Line	:	STE 520
City	:	VIENNA
State	:	VA
Zip	:	22182-3970
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	703-991-0514

Provider Business Practice Location Address
First Line	:	2549 PIEDMONT RD
Second Line	:	SUITE 120
City	:	ATLANTA
State	:	GA
Zip	:	30324
Country	:	US
Telephone Number	:	678-939-2709
Fax Number	:	404-601-0795

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	02/01/2016

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