Provider Demographics
NPI:1770540676
Name:DIXON, JOE MATHIS (OD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:MATHIS
Last Name:DIXON
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 1:1105 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2905
Mailing Address - Country:US
Mailing Address - Phone:478-987-5500
Mailing Address - Fax:478-988-4628
Practice Address - Street 1:1105 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2905
Practice Address - Country:US
Practice Address - Phone:478-987-5500
Practice Address - Fax:478-988-4628
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT 001187152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000415258BMedicaid
GA000415258CMedicaid
E94160Medicare UPIN
GA000415258CMedicaid