Provider Demographics
NPI:1861533945
Name:ALDRICH, DEAN (OD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:ALDRICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3377
Mailing Address - Country:US
Mailing Address - Phone:419-698-8584
Mailing Address - Fax:419-698-8907
Practice Address - Street 1:3127 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3377
Practice Address - Country:US
Practice Address - Phone:419-698-8584
Practice Address - Fax:419-698-8907
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2011-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5101 T2000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU80756Medicare UPIN