Provider Demographics
NPI:1316939747
Name:DALE, JOSEPH P (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:DALE
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 1:610 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:IN
Mailing Address - Zip Code:47512-9627
Mailing Address - Country:US
Mailing Address - Phone:812-735-4834
Mailing Address - Fax:812-735-4932
Practice Address - Street 1:610 WEST 11TH STREET
Practice Address - Street 2:
Practice Address - City:BICKNELL
Practice Address - State:IN
Practice Address - Zip Code:47512-9600
Practice Address - Country:US
Practice Address - Phone:812-735-4834
Practice Address - Fax:812-735-4932
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200070850Medicaid
IN410036600OtherRRMEDICARE
IN200070850Medicaid
IN410036600OtherRRMEDICARE
IN1088700001Medicare NSC