Provider Demographics
NPI:1013082148
Name:BRICKER, DALE H (OD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:H
Last Name:BRICKER
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 1:301 CHERRY HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3586
Mailing Address - Country:US
Mailing Address - Phone:541-296-1101
Mailing Address - Fax:541-298-1538
Practice Address - Street 1:301 CHERRY HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3586
Practice Address - Country:US
Practice Address - Phone:541-296-1101
Practice Address - Fax:541-298-1538
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2657ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U39369Medicare UPIN
ORR115820Medicare PIN