MEDICARE: DANIEL POTH, O.D. AND ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063454460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL POTH, O.D. AND ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 842375
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-2375
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	7702 RICHMOND HWY
Second Line	:	SUITE H
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-2803
Country	:	US
Telephone Number	:	703-717-0737
Fax Number	:	703-717-0739

Authorized Official
Title or Position	:	OWNER
Name	:	DAN POTH
Credential	:	O.D.
Telephone Number	:	703-288-1978

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/09/2013

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