Provider Demographics
NPI:1831205509
Name:DALTON, CALVIN D II (OD)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:D
Last Name:DALTON
Suffix:II
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 1:1801 HIGHWAY 129 S
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-7180
Mailing Address - Country:US
Mailing Address - Phone:706-219-4444
Mailing Address - Fax:
Practice Address - Street 1:1801 HIGHWAY 129 S
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-7180
Practice Address - Country:US
Practice Address - Phone:706-219-4444
Practice Address - Fax:706-219-1010
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002170152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
V05709Medicare UPIN
GA412CFZQMedicare ID - Type Unspecified