Provider Demographics
NPI:1366003410
Name:PIETTE, DYLAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:
Last Name:PIETTE
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 1:1881 SS RAILROAD BED RD APT 203
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-8612
Mailing Address - Country:US
Mailing Address - Phone:312-683-6610
Mailing Address - Fax:
Practice Address - Street 1:214 SAVANNAH AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5165
Practice Address - Country:US
Practice Address - Phone:912-764-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003159152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist