Provider Demographics
NPI:1023304003
Name:PEACHTREE EYE ASSOCIATES P C
Entity type:Organization
Organization Name:PEACHTREE EYE ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZUNIGA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-436-5145
Mailing Address - Street 1:4190 AVALON BLVD STE 4090
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2262
Mailing Address - Country:US
Mailing Address - Phone:678-436-5145
Mailing Address - Fax:844-572-7904
Practice Address - Street 1:4190 AVALON BLVD STE 4090
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2262
Practice Address - Country:US
Practice Address - Phone:678-436-5145
Practice Address - Fax:844-572-7904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT2392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1861671174OtherNPI