Provider Demographics
NPI:1205041712
Name:DYER, GEORGE WILLIAM (OLD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:DYER
Suffix:
Gender:M
Credentials:OLD
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 92
Mailing Address - Street 2:
Mailing Address - City:TOPSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01983-0092
Mailing Address - Country:US
Mailing Address - Phone:978-887-8500
Mailing Address - Fax:
Practice Address - Street 1:1100 BURLINGTON MALL
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803
Practice Address - Country:US
Practice Address - Phone:781-229-6623
Practice Address - Fax:781-270-9307
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist