MEDICARE: JULIE D. DANIELSON OD

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	152W00000X	Optometrist	OR3036AT	OR

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	:	1710979240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE D. DANIELSON OD

Provider Business Mailing Address
First Line	:	950 N 5TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	OR
Zip	:	97530-9016
Country	:	US
Telephone Number	:	541-899-2020
Fax Number	:	541-899-1481

Provider Business Practice Location Address
First Line	:	950 N 5TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	OR
Zip	:	97530-9016
Country	:	US
Telephone Number	:	541-899-2020
Fax Number	:	541-899-1481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	05/02/2012

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