MEDICARE: DON R DYE 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	OPT000695	GA

General Provider Information

NPI Number	:	1902045602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DON R DYE OD

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	:	OWNER
Name	:	DR. DON R DYE
Credential	:
Telephone Number	:	706-283-2351

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	11/11/2011

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