Provider Demographics
NPI:1902045602
Name:DON R DYE OD
Entity Type:Organization
Organization Name:DON R DYE OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:R
Authorized Official - Last Name:DYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-283-2351
Mailing Address - Street 1:17 S THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-2453
Mailing Address - Country:US
Mailing Address - Phone:706-283-2351
Mailing Address - Fax:706-283-3610
Practice Address - Street 1:17 S THOMAS ST
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-2453
Practice Address - Country:US
Practice Address - Phone:706-283-2351
Practice Address - Fax:706-283-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0538470001Medicare NSC