Provider Demographics
NPI:1558560839
Name:DYE, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 E CHAMPLAIN DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5010
Mailing Address - Country:US
Mailing Address - Phone:559-434-5400
Mailing Address - Fax:
Practice Address - Street 1:1145 E CHAMPLAIN DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-5010
Practice Address - Country:US
Practice Address - Phone:559-434-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
6062950001Medicare NSC