Provider Demographics
NPI:1407586167
Name:DALE, CHARLES ROBERT JR (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROBERT
Last Name:DALE
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2325 CASCADA PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-5527
Mailing Address - Country:US
Mailing Address - Phone:253-549-3074
Mailing Address - Fax:
Practice Address - Street 1:700 4TH ST
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606-5569
Practice Address - Country:US
Practice Address - Phone:830-554-9332
Practice Address - Fax:830-554-9333
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10604TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty