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General NPI Number Information
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NPI Number | 1235548603
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Entity Type | Individual
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Provider Name | LAUREN DYAK O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2014
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 485 TROWGATE LN
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City | ATLANTA
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State | GA
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Zip | 30350-6887
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Country | US
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Telephone | 303-250-9095
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Fax |
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Provider Business Mailing Address
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Address Line | 485 TROWGATE LN
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City | ATLANTA
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State | GA
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Zip | 30350-6887
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Country | US
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Telephone | 303-250-9095
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002827
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 002827
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License Number State | GA
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