Provider Demographics
NPI:1497851398
Name:COLON, GABRIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:COLON
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 1:3415 CROOKED STICK DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5794
Mailing Address - Country:US
Mailing Address - Phone:770-596-3197
Mailing Address - Fax:706-867-8679
Practice Address - Street 1:270 WALMART WAY
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-0816
Practice Address - Country:US
Practice Address - Phone:706-867-9335
Practice Address - Fax:706-867-8679
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U11914Medicare UPIN