Souleyrette, Dale
Souleyrette, Dale is an individual health care provider with primary practice located at 1709 N Dixie Ave Ste 101 , Elizabethtown KY 42701-9496. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Souleyrette, Dale can be contacted via phone (270) 765-2020.Contact Information
Primary practice address
1709 N Dixie Ave Ste 101
Elizabethtown KY 42701-9496
Phone: (270) 765-2020
Fax: (502) 765-4482
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1141DT | Kentucky |
Profile Details
| NPI number | 1205991791 |
|---|---|
| LBN Legal business name | Souleyrette, Dale |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 26th, 2006 |
| Last updated | Mar 5th, 2019 - about 5 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 | 1205991791 | NPPES |
| Kentucky | MEDICAID | 77011419 |
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