Provider Demographics
NPI:1629250329
Name:JAMES D. DILLARD, OD, PC
Entity Type:Organization
Organization Name:JAMES D. DILLARD, OD, PC
Other - Org Name:THE OPTICAL SHOPPE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:DILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-543-6006
Mailing Address - Street 1:511 GAINES SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3125
Mailing Address - Country:US
Mailing Address - Phone:706-543-6006
Mailing Address - Fax:706-543-0628
Practice Address - Street 1:511 GAINES SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3125
Practice Address - Country:US
Practice Address - Phone:706-543-6006
Practice Address - Fax:706-543-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000704332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0683340001Medicare NSC