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NPI Code Detail

MEDICARE: DR. GEORGE RONALD DIMITRI OD

MEDICARE: DR. GEORGE RONALD DIMITRI OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1098-052ATLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265491658
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE RONALD DIMITRI OD
Provider Business Mailing Address
First Line : 701 METAIRIE RD
Second Line : #205
City : METAIRIE
State : LA
Zip : 70005-4050
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1617 METAIRIE RD
Second Line :
City : METAIRIE
State : LA
Zip : 70005-3976
Country : US
Telephone Number : 504-837-3937
Fax Number : 504-837-9958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2006
Last Update Date : 07/06/2024

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