Provider Demographics
NPI:1518167089
Name:DEMPSEY, BRIAN C (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:DEMPSEY
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 1:4495 ATLANTA HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6736
Mailing Address - Country:US
Mailing Address - Phone:770-554-3456
Mailing Address - Fax:770-696-5728
Practice Address - Street 1:4495 ATLANTA HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6736
Practice Address - Country:US
Practice Address - Phone:770-554-3456
Practice Address - Fax:770-696-5728
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA781885887BMedicaid
GA781885887BMedicaid