Provider Demographics
NPI:1073661724
Name:MCNIEL, DALE EDWIN II (OD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:EDWIN
Last Name:MCNIEL
Suffix:II
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 5268
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-0268
Mailing Address - Country:US
Mailing Address - Phone:423-230-0200
Mailing Address - Fax:423-392-4978
Practice Address - Street 1:3200 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4022
Practice Address - Country:US
Practice Address - Phone:423-230-0200
Practice Address - Fax:423-392-4978
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1972152W00000X
VA0601000923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN35283OtherAVESIS
TN53876OtherDAVIS VISION
TN553234OtherNVA
TN925092OtherBLOCK VISION
TN28684OtherSPECTERA
TN4119586OtherBLUE CROSS BLUE SHIELD TN
TN41480OtherSPECTERA
TN53878OtherDAVIS VISION
TN35303OtherAVESIS
TN4119586OtherBLUE CROSS BLUE SHIELD TN