Provider Demographics
NPI:1669470480
Name:DUEY, GARY C (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
Last Name:DUEY
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 1:3405 DALLAS HWY SW
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-6426
Mailing Address - Country:US
Mailing Address - Phone:770-420-9877
Mailing Address - Fax:770-420-9898
Practice Address - Street 1:3405 DALLAS HWY SW
Practice Address - Street 2:SUITE 405
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-6426
Practice Address - Country:US
Practice Address - Phone:770-420-9877
Practice Address - Fax:770-420-9898
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52576494OtherBLUE CROSS/BLUE SHIELD
GA760646583AMedicaid
41ZCCPJMedicare PIN
GA760646583AMedicaid