Provider Demographics
NPI:1326146853
Name:EARLEY, STEPHEN CALVERT (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CALVERT
Last Name:EARLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5230 WINDWARD PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3815
Mailing Address - Country:US
Mailing Address - Phone:678-537-0009
Mailing Address - Fax:678-537-0008
Practice Address - Street 1:5230 WINDWARD PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3815
Practice Address - Country:US
Practice Address - Phone:678-537-0009
Practice Address - Fax:678-537-0008
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T29622Medicare UPIN
148471Medicare ID - Type Unspecified