MEDICARE: DAVID DALESSANDRO OD PA

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	NJ5363	NJ

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	:	1760525513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID DALESSANDRO OD PA

Provider Business Mailing Address
First Line	:	1029 MCBRIDE AVE
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-2534
Country	:	US
Telephone Number	:	973-890-9044
Fax Number	:	973-890-9054

Provider Business Practice Location Address
First Line	:	1029 MCBRIDE AVE
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-2534
Country	:	US
Telephone Number	:	973-890-9044
Fax Number	:	973-890-9054

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DAVID DALESSANDRO
Credential	:	OD
Telephone Number	:	973-890-9044

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	06/10/2024

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