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General NPI Number Information
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NPI Number | 1588716997
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Entity Type | Individual
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Provider Name | LINDA REEVES BALLENGER L.D.O.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 10366 COMMERCE ST
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City | SUMMERVILLE
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State | GA
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Zip | 30747-1471
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Country | US
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Telephone | 706-857-7777
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Fax | 706-857-7877
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Provider Business Mailing Address
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Address Line | 10366 COMMERCE ST
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City | SUMMERVILLE
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State | GA
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Zip | 30747-1471
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Country | US
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Telephone | 706-857-7777
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Fax | 706-857-7877
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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 | GA963
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 894
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License Number State | GA
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