Organization
DALE W MUTH OD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE W MUTH OD (OPTOMETRIST)
(906) 293-9276
Entity
Organization
Contact information
Practice address
504 W HARRIE ST, NEWBERRY, MI 49868-1200
(902) 293-9276
(906) 293-9100
Mailing address
504 W HARRIE ST, NEWBERRY, MI 49868-1200
(902) 293-9276
(906) 293-9100
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003944
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900D800030
BCBS OF MICHIGAN
MI
05
—
944255821
—
MI
Enumeration date
03/09/2007
Last updated
06/09/2015
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