Provider Demographics
NPI:1073509865
Name:DALEY, ERIC PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PAUL
Last Name:DALEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-0695
Mailing Address - Country:US
Mailing Address - Phone:717-485-4133
Mailing Address - Fax:717-485-4179
Practice Address - Street 1:7297 CITO RD
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-8703
Practice Address - Country:US
Practice Address - Phone:717-485-4133
Practice Address - Fax:717-485-4179
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA528768OtherBLUE SHIELD
PA50042626OtherCAPITAL BLUE CROSS
PA5349050001Medicare NSC
PA528768OtherBLUE SHIELD
528768TPXMedicare ID - Type Unspecified