Provider Demographics
NPI:1174757090
Name:PEACH OPTICS
Entity type:Organization
Organization Name:PEACH OPTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:I
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-869-5551
Mailing Address - Street 1:2900 PEACHTREE RD NW
Mailing Address - Street 2:SUITE#301
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-4915
Mailing Address - Country:US
Mailing Address - Phone:404-869-5551
Mailing Address - Fax:404-869-5181
Practice Address - Street 1:2900 PEACHTREE RD NW
Practice Address - Street 2:SUITE#301
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-4915
Practice Address - Country:US
Practice Address - Phone:404-869-5551
Practice Address - Fax:404-869-5181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2240152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty