MEDICARE: MICHAEL E DALTON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4188	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	004188	OTHER	TUFT HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	152629	OTHER	HARVARD PILGRAM HLTH CARE
4	W16265	OTHER	BLUE CROSS B S OF MA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174573521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E DALTON OD

Provider Business Mailing Address
First Line	:	50 STANIFORD ST
Second Line	:	SUITE 600
City	:	BOSTON
State	:	MA
Zip	:	02114-2517
Country	:	US
Telephone Number	:	617-367-4800
Fax Number	:	617-723-7028

Provider Business Practice Location Address
First Line	:	50 STANIFORD ST
Second Line	:	SUITE 600
City	:	BOSTON
State	:	MA
Zip	:	02114-2517
Country	:	US
Telephone Number	:	617-367-4800
Fax Number	:	617-723-7028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	12/11/2015

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Directions to “ MICHAEL E DALTON OD” Practice Location

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