Provider Demographics
NPI:1255318150
Name:STEIN, DALE M
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:M
Last Name:STEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 VOORHEES TOWN CTR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1910
Mailing Address - Country:US
Mailing Address - Phone:856-772-6331
Mailing Address - Fax:
Practice Address - Street 1:2095 VOORHEES TOWN CTR
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1910
Practice Address - Country:US
Practice Address - Phone:856-772-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00426500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U19746Medicare UPIN
516213NE6Medicare ID - Type Unspecified