MEDICARE: DALTON EYECARE PROFESSIONALS, PC

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
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1316168107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALTON EYECARE PROFESSIONALS, PC

Provider Business Mailing Address
First Line	:	262 S MAIN ST
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-1403
Country	:	US
Telephone Number	:	706-219-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	262 S MAIN ST
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-1403
Country	:	US
Telephone Number	:	706-219-4444
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CALVIN D DALTON II
Credential	:	O.D.
Telephone Number	:	706-219-4444

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	08/22/2020

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