Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2657ATI | OR |
NPI | 1013082148 |
---|---|
Provider Name | Dr. Dale H Bricker |
First Address | The Dalles, OR 97058-3586 |
Second Address | The Dalles, OR 97058-3586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 13/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U39369 | (02) |