Provider Demographics
NPI:1194885848
Name:ANANIA, DOUGLAS A (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:ANANIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12924 HIGHWAY 92 STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5193
Mailing Address - Country:US
Mailing Address - Phone:678-717-9121
Mailing Address - Fax:770-926-2287
Practice Address - Street 1:12924 HIGHWAY 92 STE 100
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5193
Practice Address - Country:US
Practice Address - Phone:678-717-9121
Practice Address - Fax:770-926-2287
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1885152W00000X
GAOPT002416152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VO2551Medicare UPIN