Healthcare Provider Details

I. General information

NPI: 1093719627
Provider Name (Legal Business Name): DALE P LINDSEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DALE P LINDSEY O.D., INC.

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 06/23/2006

III. Provider practice location address

122 FOWLER ST
CORTLAND OH
44410-1328
US

IV. Provider business mailing address

122 FOWLER ST
CORTLAND OH
44410-1328
US

V. Phone/Fax

Practice location:
  • Phone: 330-638-8599
  • Fax: 330-638-8551
Mailing address:
  • Phone: 330-638-8599
  • Fax: 330-638-8551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3679T543
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number3679T543
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: