Provider Demographics
NPI:1710928908
Name:LLOYD, GEORGE HAROLD JR (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HAROLD
Last Name:LLOYD
Suffix:JR
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:PO BOX 229
Mailing Address - Street 2:233 CEDAR AVE
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380
Mailing Address - Country:US
Mailing Address - Phone:423-837-8611
Mailing Address - Fax:423-837-8612
Practice Address - Street 1:233 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380
Practice Address - Country:US
Practice Address - Phone:423-837-8611
Practice Address - Fax:423-837-8612
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT860152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3595048Medicaid
TN3595048Medicare PIN
TNT61224Medicare UPIN
TN410000100Medicare PIN
TN0170260001Medicare NSC