Deborah K Deloach, LDO
Individual provider Active NPI Optician · Vidalia, GA
NPI 1609654292 · NPPES record last updated Sep 15, 2023
Key facts
- NPI
- 1609654292
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optician 156FX1800X
- License
- LDO002114 (GA)
- Practice address
- 3109 E 1St St
Vidalia, GA 30474-8830 - Phone
- (912) 537-2436
- Fax
- (912) 537-2659
- NPI assigned
- Sep 15, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LDO002114 | GA | MD | Optician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | LDO002114 | GA | Yes |
Addresses
Primary practice location
3109 E 1St St
Vidalia, GA 30474-8830
Mailing address
3109 E 1St St
Vidalia, GA 30474-8830
Phone (912) 537-2436
Other providers in Vidalia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.