Provider Demographics
NPI:1801943014
Name:NOVAK, DALE CARL I (OD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:CARL
Last Name:NOVAK
Suffix:I
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 1:4314 MILAN RD
Mailing Address - Street 2:SEARS OPTICAL
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5897
Mailing Address - Country:US
Mailing Address - Phone:419-626-6415
Mailing Address - Fax:
Practice Address - Street 1:4314 MILAN RD
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5897
Practice Address - Country:US
Practice Address - Phone:419-626-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist