Provider Demographics
NPI:1477632065
Name:DALY, DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:DALY
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:PO BOX 8007
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-0007
Mailing Address - Country:US
Mailing Address - Phone:612-819-3475
Mailing Address - Fax:651-644-5301
Practice Address - Street 1:3042 HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2614
Practice Address - Country:US
Practice Address - Phone:612-819-3475
Practice Address - Fax:651-644-5301
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410003627Medicare PIN