Provider Demographics
NPI:1306825450
Name:MCDONALD, DEBORAH F (OD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:F
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 N ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1709
Mailing Address - Country:US
Mailing Address - Phone:229-247-8484
Mailing Address - Fax:229-247-7996
Practice Address - Street 1:3001 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1709
Practice Address - Country:US
Practice Address - Phone:229-247-8484
Practice Address - Fax:229-247-7996
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001047152W00000X
FLOPT001915152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
41CZDLBOtherMEDICARE PTAN
GA000345694HMedicaid
GA00345694IMedicaid
U19636Medicare UPIN