Basic Information
| Provider Information | |||||||||
| NPI: | 1093366940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEFF | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | TYLER | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3655 HOWELL FERRY RD | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300963186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703735822 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3655 HOWELL FERRY RD | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300963186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703735822 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2019 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156F00000X | RBT-19-98556 | IL | Y | Eye and Vision Services Providers | Technician/Technologist |
ID Information
| ID | Type | State | Issuer | Description | RBT-19-98556 | 01 | BACB | OTHER |