Individual
DALE SOULEYRETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1709 N DIXIE AVE STE 101, ELIZABETHTOWN, KY 42701-9496
(270) 765-2020
(502) 765-4482
Mailing address
11103 WEST AVE, SUITE 6, SAN ANTONIO, TX 78213-1370
(210) 524-6663
(210) 524-6587
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1141DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77011419
—
KY
Enumeration date
12/26/2006
Last updated
03/05/2019
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