Provider Demographics
NPI:1225336613
Name:DASINGER, KELLEY DAVIS (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:DAVIS
Last Name:DASINGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KELLEY
Other - Middle Name:LYNN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5983 HIGHWAY 53 E
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-9513
Mailing Address - Country:US
Mailing Address - Phone:706-216-6595
Mailing Address - Fax:706-216-6594
Practice Address - Street 1:46 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-0800
Practice Address - Country:US
Practice Address - Phone:706-864-7000
Practice Address - Fax:706-216-6594
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002853152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist