MEDICARE: DR. ANTHONY DYLAN REACH O.D.

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	1859	GA

General Provider Information

NPI Number	:	1609901479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY DYLAN REACH O.D.

Provider Business Mailing Address
First Line	:	4900 IVEY RD NW STE 1226
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-4108
Country	:	US
Telephone Number	:	770-974-3153
Fax Number	:	770-974-3154

Provider Business Practice Location Address
First Line	:	4900 IVEY RD NW STE 1226
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-4108
Country	:	US
Telephone Number	:	770-974-3153
Fax Number	:	770-974-3154

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	11/29/2021

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