Provider Demographics
NPI:1083779565
Name:TRESTON, JAMES H (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:TRESTON
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 1:28 FOLIAGE TRL
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-6223
Mailing Address - Country:US
Mailing Address - Phone:912-748-9597
Mailing Address - Fax:
Practice Address - Street 1:160 POOLER PKWY
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4200
Practice Address - Country:US
Practice Address - Phone:912-748-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPT002342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA500797411AMedicaid
GAP00364197OtherRR MEDICARE
GA500797411AMedicaid