MEDICARE: DANIEL MAX & MARC ANDREA LLC

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

General Provider Information

NPI Number	:	1720837081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL MAX & MARC ANDREA LLC

Provider Business Mailing Address
First Line	:	1615 S CONGRESS AVE STE 105
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6326
Country	:	US
Telephone Number	:	561-208-8464
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 SE 15TH ST
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-3966
Country	:	US
Telephone Number	:	405-930-3800
Fax Number	:	405-930-3801

Authorized Official
Title or Position	:	MANAGER OF HEALTH SERVICES
Name	:	KIRSTEN PIPHER CANTRELL
Credential	:
Telephone Number	:	561-208-8464

Provider Enumeration Date	:	05/17/2024
Last Update Date	:	05/17/2024

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