Mortimer, Michael Dale

Mortimer, Michael Dale is an individual health care provider with primary practice located at 130 S Union St Ste. 8, Olean NY 14760-9807. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Mortimer, Michael Dale can be contacted via phone (716) 372-8644.

Contact Information

Primary practice address
130 S Union St Ste. 8 Olean NY 14760-9807
Phone: (716) 372-8644
Fax: (716) 373-4257
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 3906 New York

Profile Details

NPI number 1801881578
LBN Legal business name Mortimer, Michael Dale
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 19th, 2005
Last updated Jan 21st, 2009 - about 16 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801881578 NPPES
New York Other NY3906 EYEMED
New York MEDICAID 00606964 EYEMED

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