Provider Demographics
NPI:1841275757
Name:DYE, DON R (OD)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:R
Last Name:DYE
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 1:17 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000003781AMedicaid
GA55508054SAMedicare ID - Type Unspecified
GA000003781AMedicaid
GA0538470001Medicare NSC
GAU11410Medicare UPIN