Provider Demographics
NPI:1508101510
Name:AYEWOH, SYLVESTER (OD)
Entity Type:Individual
Prefix:DR
First Name:SYLVESTER
Middle Name:
Last Name:AYEWOH
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 1:3765 ATTICUS AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-7257
Mailing Address - Country:US
Mailing Address - Phone:678-457-7048
Mailing Address - Fax:
Practice Address - Street 1:4373 JIMMY LEE SMITH PKWY STE 101
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2629
Practice Address - Country:US
Practice Address - Phone:770-943-2220
Practice Address - Fax:770-943-4245
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist