Provider Demographics
NPI:1932250230
Name:DEW, JOE H (OD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:H
Last Name:DEW
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 788
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-0788
Mailing Address - Country:US
Mailing Address - Phone:770-267-2573
Mailing Address - Fax:770-267-6751
Practice Address - Street 1:428 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1908
Practice Address - Country:US
Practice Address - Phone:770-267-2573
Practice Address - Fax:770-267-6751
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA654T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000003726AMedicaid
GAT97543Medicare UPIN
GA0638110001Medicare NSC
GA55279254SAMedicare PIN