Individual
DALTON BROTHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2019019333
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2500054965
BUREAU OF NARCOTICS & DANGEROUS DRUGS (BNDD)
MO
Enumeration date
06/03/2019
Last updated
06/10/2019
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