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General NPI Number Information
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NPI Number | 1073661724
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Entity Type | Individual
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Provider Name | DALE EDWIN MCNIEL II OD
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3200 FORT HENRY DR
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City | KINGSPORT
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State | TN
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Zip | 37664-4022
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Country | US
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Telephone | 423-230-0200
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Fax | 423-392-4978
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Provider Business Mailing Address
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Address Line | PO BOX 5268
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City | KINGSPORT
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State | TN
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Zip | 37663-0268
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Country | US
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Telephone | 423-230-0200
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Fax | 423-392-4978
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1972
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0601000923
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License Number State | VA
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