Individual
DALE LEROY BUCKWALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2248 D ST, LAVERNE, CA 91750
(909) 593-3519
(909) 593-3521
Mailing address
PO BOX 720084, PINON HILLS, CA 92372
(760) 868-2101
(760) 868-2101
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5015T
CA
Other
Enumeration date
02/05/2007
Last updated
07/08/2007
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