Provider Demographics
NPI:1063653632
Name:MICHAEL DALESIO OD P A
Entity Type:Organization
Organization Name:MICHAEL DALESIO OD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:D'ALESIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-687-5638
Mailing Address - Street 1:2241 SPRINGRAIN DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2238
Mailing Address - Country:US
Mailing Address - Phone:727-687-5638
Mailing Address - Fax:
Practice Address - Street 1:8001 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-1744
Practice Address - Country:US
Practice Address - Phone:727-568-0385
Practice Address - Fax:727-578-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty