Provider Demographics
NPI:1982612800
Name:BELT, DYLAN B (OD)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:B
Last Name:BELT
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 1:108 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1712
Mailing Address - Country:US
Mailing Address - Phone:757-562-4321
Mailing Address - Fax:757-562-3378
Practice Address - Street 1:108 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1712
Practice Address - Country:US
Practice Address - Phone:757-562-4321
Practice Address - Fax:757-562-3378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002305152W00000X
VA0618001815152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA392334055AMedicaid
GA392334055AMedicaid
GA41ZCGCRMedicare PIN