Provider Demographics
NPI:1710049168
Name:DIXON, CATHY L (LDO)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:DIXON
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 N COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2382
Mailing Address - Country:US
Mailing Address - Phone:478-452-3593
Mailing Address - Fax:478-453-0016
Practice Address - Street 1:1841 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2382
Practice Address - Country:US
Practice Address - Phone:478-452-3593
Practice Address - Fax:478-453-0016
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001648156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA25391OtherAVESIS
GA00897487AMedicaid
GA100921OtherAVESIS M'CAID
GA07820OtherSPECTERA
GA25391OtherAVESIS
GA25391OtherAVESIS