MEDICARE: DR. DAVID DALY 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	152W00000X	Optometrist	1758	MN

General Provider Information

NPI Number	:	1477632065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID DALY O.D.

Provider Business Mailing Address
First Line	:	PO BOX 8007
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-0007
Country	:	US
Telephone Number	:	612-819-3475
Fax Number	:	651-644-5301

Provider Business Practice Location Address
First Line	:	3042 HENNEPIN AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2614
Country	:	US
Telephone Number	:	612-819-3475
Fax Number	:	651-644-5301

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	04/19/2012

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