Provider Demographics
NPI:1174573521
Name:DALTON, MICHAEL E (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:DALTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-367-4800
Mailing Address - Fax:617-723-7028
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 600
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-367-4800
Practice Address - Fax:617-723-7028
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4188152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
004188OtherTUFT HEALTH PLAN
MA0335151Medicaid
152629OtherHARVARD PILGRAM HLTH CARE
W16265OtherBLUE CROSS B S OF MA
MA110014782AMedicaid
U83625Medicare UPIN
MA0335151Medicaid
152629OtherHARVARD PILGRAM HLTH CARE