Healthcare Provider Details

I. General information

NPI: 1841275757
Provider Name (Legal Business Name): DON R DYE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 S THOMAS ST
ELBERTON GA
30635-2453
US

IV. Provider business mailing address

17 S THOMAS ST
ELBERTON GA
30635-2453
US

V. Phone/Fax

Practice location:
  • Phone: 706-283-2351
  • Fax: 706-283-3610
Mailing address:
  • Phone: 706-283-2351
  • Fax: 706-283-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number695
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: