Massignan, Dale T
Massignan, Dale T is an sole proprietor health care provider with primary practice located at 523 East Wall Street , Eagle River WI 54521. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Massignan, Dale T can be contacted via phone (715) 479-6489.Contact Information
Primary practice address
523 East Wall Street
Eagle River WI 54521
Phone: (715) 479-6489
Fax: (715) 479-6200
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1821 | Wisconsin |
Profile Details
| NPI number | 1760487607 |
|---|---|
| LBN Legal business name | Massignan, Dale T |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 16th, 2005 |
| Last updated | Jan 2nd, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760487607 | NPPES |
| Wisconsin | MEDICAID | 38517000 |
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