Dima Ivonne Clanton, LDO
Technician/Technologist, Optician in Atlanta, GA. Individual provider (NPI-1).
NPI number1366719957
StatusActive
Last updated in NPPESNov 26, 2011
Details
- NPI
- 1366719957
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Dima Ivonne Clanton
- Credential
- LDO
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 26, 2011
- Last updated
- Nov 26, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156FX1800X | Technician/Technologist, Optician | LDO002424 | GA | Yes |
Practice location
4166 Buford Hwy Ne Ste S6-T5Atlanta, GA 30345-1081
Phone 404-855-3888 · Fax 404-855-4388
Mailing address
2554 Gadsen WalkDuluth, GA 30097-4349
Phone 678-417-1712
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