Provider Demographics
NPI:1306035936
Name:DALTON EYE CENTER, LLC
Entity type:Organization
Organization Name:DALTON EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:706-277-2077
Mailing Address - Street 1:1510 N THORNTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8517
Mailing Address - Country:US
Mailing Address - Phone:706-277-2077
Mailing Address - Fax:706-277-2021
Practice Address - Street 1:1510 N THORNTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8517
Practice Address - Country:US
Practice Address - Phone:706-277-2077
Practice Address - Fax:706-277-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO2049332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies