MEDICARE: DR. DON R DYE 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	695	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1841275757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DON R DYE O.D.

Provider Business Mailing Address
First Line	:	17 S THOMAS ST
Second Line	:
City	:	ELBERTON
State	:	GA
Zip	:	30635-2453
Country	:	US
Telephone Number	:	706-283-2351
Fax Number	:	706-283-3610

Provider Business Practice Location Address
First Line	:	17 S THOMAS ST
Second Line	:
City	:	ELBERTON
State	:	GA
Zip	:	30635-2453
Country	:	US
Telephone Number	:	706-283-2351
Fax Number	:	706-283-3610

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	11/11/2011

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