Provider Demographics
NPI:1215792791
Name:NAROVICH, DALLAS STARLING (LDO)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:STARLING
Last Name:NAROVICH
Suffix:
Gender:F
Credentials:LDO
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 313
Mailing Address - Street 2:
Mailing Address - City:GIBSON
Mailing Address - State:GA
Mailing Address - Zip Code:30810-0313
Mailing Address - Country:US
Mailing Address - Phone:912-237-0066
Mailing Address - Fax:
Practice Address - Street 1:2205 HARRISON RD
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-7455
Practice Address - Country:US
Practice Address - Phone:912-237-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002926156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician