Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1108 | NC |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1108 | NC |
NPI | 1255330254 |
---|---|
Provider Name | Dr. Dale D. Stewart |
First Address | Vienna, VA 22182-3970 |
Second Address | Durham, NC 27705-4640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8909867 | (05) | NC |
T64953 | (02) | NC |