Provider Demographics
NPI:1255330254
Name:STEWART, DALE D (OD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:D
Last Name:STEWART
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2200 W MAIN ST
Practice Address - Street 2:#A160
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4640
Practice Address - Country:US
Practice Address - Phone:919-286-2912
Practice Address - Fax:919-286-1125
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1108152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909867Medicaid
NC8909867Medicaid
NCT64953Medicare UPIN