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General NPI Number Information
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NPI Number | 1306035936
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Entity Type | Organization
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Legal Business Name | DALTON EYE CENTER, LLC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 1510 N THORNTON AVE SUITE 210
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City | DALTON
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State | GA
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Zip | 30720-8517
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Country | US
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Telephone | 706-277-2077
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Fax | 706-277-2021
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Provider Business Mailing Address
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Address Line | 1510 N THORNTON AVE SUITE 210
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City | DALTON
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State | GA
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Zip | 30720-8517
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Country | US
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Telephone | 706-277-2077
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Fax | 706-277-2021
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KIMBERLY L BATES
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Credential | LDO
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Telephone | 706-277-2077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | LDO2049
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License Number State | GA
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