Provider Demographics
NPI:1003155458
Name:DALE K MEYER
Entity Type:Organization
Organization Name:DALE K MEYER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-866-7784
Mailing Address - Street 1:201 N MAIN ST
Mailing Address - Street 2:POST OFFICE BOX 188
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1918
Mailing Address - Country:US
Mailing Address - Phone:315-866-7784
Mailing Address - Fax:315-866-7785
Practice Address - Street 1:201 N MAIN ST
Practice Address - Street 2:POST OFFICE BOX 188
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1918
Practice Address - Country:US
Practice Address - Phone:315-866-7784
Practice Address - Fax:315-866-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26720Medicare UPIN
NY50585BMedicare PIN