Provider Demographics
NPI:1295516748
Name:RAY, YEVETTE SUZETTE (LDO)
Entity type:Individual
Prefix:MRS
First Name:YEVETTE
Middle Name:SUZETTE
Last Name:RAY
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 HIGHWAY 441 S
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-7607
Mailing Address - Country:US
Mailing Address - Phone:706-782-6961
Mailing Address - Fax:
Practice Address - Street 1:1455 HIGHWAY 441 S
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-7607
Practice Address - Country:US
Practice Address - Phone:706-782-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002654156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician