Provider Demographics
NPI:1619931573
Name:ROYAL, KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:
Last Name:ROYAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 E DOYLE ST
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-3009
Mailing Address - Country:US
Mailing Address - Phone:706-886-5214
Mailing Address - Fax:706-282-1451
Practice Address - Street 1:58 E DOYLE ST
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-3009
Practice Address - Country:US
Practice Address - Phone:706-886-5214
Practice Address - Fax:706-282-1451
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001460152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000626216BMedicaid
SCDAG980Medicaid
GAU53596Medicare UPIN
GA000626216BMedicaid