MEDICARE: DR. MARK ALAN DALTON O.D.

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	152WC0802X	Corneal and Contact Management Optometrist	2002015836	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942291547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALAN DALTON O.D.

Provider Business Mailing Address
First Line	:	PO BOX 280
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-0280
Country	:	US
Telephone Number	:	573-468-2020
Fax Number	:	877-428-6732

Provider Business Practice Location Address
First Line	:	14 COMMUNITY PLZ
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080-1567
Country	:	US
Telephone Number	:	573-468-2020
Fax Number	:	636-556-9952

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	08/07/2014

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