Provider Demographics
NPI:1740340967
Name:DALESIO, DAVID FRANCIS (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FRANCIS
Last Name:DALESIO
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 1:8801 COLLEGE PKWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4882
Mailing Address - Country:US
Mailing Address - Phone:239-437-2004
Mailing Address - Fax:239-437-0501
Practice Address - Street 1:8801 COLLEGE PKWY
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4882
Practice Address - Country:US
Practice Address - Phone:239-437-2004
Practice Address - Fax:239-437-0501
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2508152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20359ZMedicare ID - Type UnspecifiedMEDICARE NUMBER
FLU28677Medicare UPIN
FL38445Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER