Provider Demographics
NPI:1164435640
Name:SCHELL, DALE (OD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:
Last Name:SCHELL
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 1:2501 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1300
Mailing Address - Country:US
Mailing Address - Phone:480-224-6917
Mailing Address - Fax:480-224-6919
Practice Address - Street 1:2501 S MARKET ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1300
Practice Address - Country:US
Practice Address - Phone:480-224-6917
Practice Address - Fax:480-224-6919
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2010-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1368152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ111853Medicare PIN
AZU98569Medicare UPIN