Provider Demographics
NPI:1386747640
Name:MORESI, PETER J (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:MORESI
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:STE 520
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:2549 PIEDMONT RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324
Practice Address - Country:US
Practice Address - Phone:678-939-2709
Practice Address - Fax:404-601-0795
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2016-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAOPT1083152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA204999784OtherTAX ID
GAU22533Medicare UPIN