MEDICARE: DR. DANIEL JUEL BRINCHMAN 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	8501TG	TX

General Provider Information

NPI Number	:	1821404302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JUEL BRINCHMAN OD

Provider Business Mailing Address
First Line	:	4800 S HULEN ST STE 1520
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1554
Country	:	US
Telephone Number	:	817-769-8566
Fax Number	:

Provider Business Practice Location Address
First Line	:	3811 S COOPER ST STE 2310
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-4148
Country	:	US
Telephone Number	:	817-466-9211
Fax Number	:

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

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	05/06/2024

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