Individual
DR. MICHAEL DALE MORTIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
130 S UNION ST, STE. 8, OLEAN, NY 14760-9807
(716) 372-8644
(716) 373-4257
Mailing address
130 S UNION ST, STE. 8, OLEAN, NY 14760-9807
(716) 372-8644
(716) 373-4257
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3906
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00606964
—
NY
01
—
NY3906
EYEMED
NY
Enumeration date
09/19/2005
Last updated
01/21/2009
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