Provider Demographics
NPI:1831248293
Name:MEYER, DALE K (OD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:K
Last Name:MEYER
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 1:2005 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-7016
Mailing Address - Country:US
Mailing Address - Phone:518-456-4883
Mailing Address - Fax:518-689-7617
Practice Address - Street 1:2005 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-7016
Practice Address - Country:US
Practice Address - Phone:518-456-4883
Practice Address - Fax:518-689-7617
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT-004511152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10024635OtherCDPHP HEALTH PLAN
NY141687844OtherBSNENY
NY141687844OtherEMPIRE BCBS
NY341309OtherMVP HEALTH PLAN
NY10024635OtherCDPHP HEALTH PLAN
NYT26720Medicare UPIN