Healthcare Provider Details

I. General information

NPI: 1164435954
Provider Name (Legal Business Name): DENIS L MCDONALD OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 HWY 136
TRENTON GA
30752
US

IV. Provider business mailing address

PO BOX 156
TRENTON GA
30752-0156
US

V. Phone/Fax

Practice location:
  • Phone: 706-657-7559
  • Fax: 706-657-3937
Mailing address:
  • Phone: 706-657-7559
  • Fax: 706-657-3937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 002234
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: