Provider Demographics
NPI:1093719627
Name:LINDSEY, DALE P (OD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:P
Last Name:LINDSEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:DALE
Other - Middle Name:P
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD, INC
Mailing Address - Street 1:122 FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1328
Mailing Address - Country:US
Mailing Address - Phone:330-638-8599
Mailing Address - Fax:330-638-8551
Practice Address - Street 1:122 FOWLER ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1328
Practice Address - Country:US
Practice Address - Phone:330-638-8599
Practice Address - Fax:330-638-8551
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-03-28
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-06-23
Provider Licenses
StateLicense IDTaxonomies
OH3679T543152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0573786Medicaid
1093719627OtherNPI
T48543Medicare UPIN
LI0595412Medicare ID - Type Unspecified
OH0152460001Medicare NSC