Provider Demographics
NPI:1083042253
Name:NORTHSIDE EYE PARTNERS, PC
Entity type:Organization
Organization Name:NORTHSIDE EYE PARTNERS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUJI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:678-903-2579
Mailing Address - Street 1:2230 ROSWELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2939
Mailing Address - Country:US
Mailing Address - Phone:678-903-2579
Mailing Address - Fax:678-903-2583
Practice Address - Street 1:2230 ROSWELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2939
Practice Address - Country:US
Practice Address - Phone:678-903-2579
Practice Address - Fax:678-903-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7082160001Medicare NSC