Provider Demographics
NPI:1477185205
Name:KLAUSS, DALE A (LDO)
Entity Type:Individual
Prefix:MS
First Name:DALE
Middle Name:A
Last Name:KLAUSS
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 KENWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3451
Mailing Address - Country:US
Mailing Address - Phone:770-815-9254
Mailing Address - Fax:
Practice Address - Street 1:294 KENWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3451
Practice Address - Country:US
Practice Address - Phone:770-815-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO000702156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician