Provider Demographics
NPI:1396229340
Name:EARLS, PAMELA DENISE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DENISE
Last Name:EARLS
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 1:101 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-7536
Mailing Address - Country:US
Mailing Address - Phone:478-474-4024
Mailing Address - Fax:
Practice Address - Street 1:101 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-7536
Practice Address - Country:US
Practice Address - Phone:478-474-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist