Provider Demographics
NPI:1598928913
Name:EYE ON PEACHTREE INC.
Entity Type:Organization
Organization Name:EYE ON PEACHTREE INC.
Other - Org Name:ANSLEY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REENA
Authorized Official - Middle Name:CHOPRA
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-580-8458
Mailing Address - Street 1:1544 PIEDMONT AVE NE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5018
Mailing Address - Country:US
Mailing Address - Phone:404-888-9444
Mailing Address - Fax:404-888-9666
Practice Address - Street 1:1544 PIEDMONT AVE NE
Practice Address - Street 2:SUITE 320
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5018
Practice Address - Country:US
Practice Address - Phone:404-888-9444
Practice Address - Fax:404-888-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002285261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center