Provider Demographics
NPI:1134669807
Name:DR. JOSEPH P. DALE LLC
Entity Type:Organization
Organization Name:DR. JOSEPH P. DALE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-735-4834
Mailing Address - Street 1:610 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:IN
Mailing Address - Zip Code:47512-9627
Mailing Address - Country:US
Mailing Address - Phone:812-735-4834
Mailing Address - Fax:
Practice Address - Street 1:610 W 11TH ST
Practice Address - Street 2:
Practice Address - City:BICKNELL
Practice Address - State:IN
Practice Address - Zip Code:47512-9627
Practice Address - Country:US
Practice Address - Phone:812-735-4834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200070850Medicaid
IN306783095Medicare UPIN