Provider Demographics
NPI:1821016445
Name:DEPLONTY, CINDY LOU (OD)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LOU
Last Name:DEPLONTY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LOU
Other - Last Name:OWSIAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:6490 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909
Mailing Address - Country:US
Mailing Address - Phone:706-653-6202
Mailing Address - Fax:706-653-9204
Practice Address - Street 1:1403-D WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-323-3652
Practice Address - Fax:706-323-5074
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00627338FMedicaid
GA00627338FMedicaid
GA41ZCFKKMedicare ID - Type Unspecified