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NPI Code Detail

MEDICARE: DR. GARY C DUEY O.D.

MEDICARE: DR. GARY C DUEY 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
1152W00000XOptometristOPT001420GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
152576494OTHERGABLUE CROSS/BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669470480
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY C DUEY O.D.
Provider Business Mailing Address
First Line : 3405 DALLAS HWY SW
Second Line : SUITE 405
City : MARIETTA
State : GA
Zip : 30064-6426
Country : US
Telephone Number : 770-420-9877
Fax Number : 770-420-9898
Provider Business Practice Location Address
First Line : 3405 DALLAS HWY SW
Second Line : SUITE 405
City : MARIETTA
State : GA
Zip : 30064-6426
Country : US
Telephone Number : 770-420-9877
Fax Number : 770-420-9898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 10/30/2013

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