Provider Demographics
NPI:1275538225
Name:COLE, DALE KENNETH (OD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:KENNETH
Last Name:COLE
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 1:1000 E CLOUD ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6416
Mailing Address - Country:US
Mailing Address - Phone:785-823-6391
Mailing Address - Fax:785-823-7188
Practice Address - Street 1:1000 E CLOUD ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-6416
Practice Address - Country:US
Practice Address - Phone:785-823-6391
Practice Address - Fax:785-823-7188
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1004-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5684030001OtherCIGNA MEDICARE
KS640760OtherFIRSTGUARD
KS651102OtherBCBS
KS640760OtherFIRSTGUARD
KST43638Medicare UPIN