Provider Demographics
NPI:1164435954
Name:MCDONALD, DENIS L (OD)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:L
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-0156
Mailing Address - Country:US
Mailing Address - Phone:706-657-7559
Mailing Address - Fax:706-657-3937
Practice Address - Street 1:5377 HWY 136
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752
Practice Address - Country:US
Practice Address - Phone:706-657-7559
Practice Address - Fax:706-657-3937
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT 002234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid
GAPENDINGMedicaid
3597761Medicare ID - Type Unspecified