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NPI Code Detail

MEDICARE: DR. JERRY M OVERALL O.D.

MEDICARE: DR. JERRY M OVERALL O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPT000678GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871550426
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JERRY M OVERALL O.D.
Provider Business Mailing Address
First Line : 208 SMITH ST
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2755
Country : US
Telephone Number : 706-882-0166
Fax Number : 706-883-7363
Provider Business Practice Location Address
First Line : 208 SMITH ST
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2755
Country : US
Telephone Number : 706-882-0166
Fax Number : 706-883-7363
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 10/31/2007

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