Provider Demographics
NPI:1760478515
Name:BYARS, TOMMY JOEL (OD)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:JOEL
Last Name:BYARS
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:PO BOX 37
Mailing Address - Street 2:5916 JONESBORO RD
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-0037
Mailing Address - Country:US
Mailing Address - Phone:770-961-4967
Mailing Address - Fax:770-961-1086
Practice Address - Street 1:5916 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1103
Practice Address - Country:US
Practice Address - Phone:770-961-4967
Practice Address - Fax:770-961-1086
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0648T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00003451BMedicaid
U22217Medicare UPIN