MEDICARE: DR. DYLAN PIETTE 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
1	152W00000X	Optometrist	OPT003159	GA

General Provider Information

NPI Number	:	1366003410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DYLAN PIETTE OD

Provider Business Mailing Address
First Line	:	1881 SS RAILROAD BED RD APT 203
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30461-8612
Country	:	US
Telephone Number	:	312-683-6610
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 SAVANNAH AVE
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-5165
Country	:	US
Telephone Number	:	912-764-5609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	08/08/2023

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Directions to “ DR. DYLAN PIETTE OD” Practice Location

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