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General NPI Number Information
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NPI Number | 1033352497
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Entity Type | Organization
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Legal Business Name | JOE H. DEW, O. D. P. A.
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Dates
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Enumeration Date | 04/15/2009
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Last Update Date | 04/15/2009
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Provider Practice Location Address
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Address Line | 428 W HIGHLAND AVE
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City | MONROE
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State | GA
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Zip | 30655-1908
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Country | US
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Telephone | 770-267-2573
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Fax | 770-267-6751
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Provider Business Mailing Address
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Address Line | PO BOX 788
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City | MONROE
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State | GA
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Zip | 30655-0788
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Country | US
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Telephone | 770-267-2573
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Fax | 770-267-6751
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOE H DEW
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Credential | O. D.
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Telephone | 770-267-2573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 654T
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License Number State | GA
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