Individual
DR. DALE EDWIN MCNIEL II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3200 FORT HENRY DR, KINGSPORT, TN 37664-4022
(423) 230-0200
(423) 392-4978
Mailing address
PO BOX 5268, KINGSPORT, TN 37663-0268
(423) 230-0200
(423) 392-4978
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0601000923
VA
152W00000X
Optometrist
Primary
1972
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28684
SPECTERA
TN
01
—
35283
AVESIS
TN
01
—
35303
AVESIS
TN
01
—
4119586
BLUE CROSS BLUE SHIELD TN
TN
01
—
41480
SPECTERA
TN
01
—
53876
DAVIS VISION
TN
01
—
53878
DAVIS VISION
TN
01
—
553234
NVA
TN
01
—
925092
BLOCK VISION
TN
Enumeration date
01/08/2007
Last updated
07/09/2007
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