MEDICARE: JAWAD DANIEL 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	0618002339	VA
2	152W00000X	Optometrist	TUV008735	NY

General Provider Information

NPI Number	:	1841605730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAWAD DANIEL OD

Provider Business Mailing Address
First Line	:	400 WESTHAMPTON STA
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-3330
Country	:	US
Telephone Number	:	804-287-4200
Fax Number	:	804-287-4210

Provider Business Practice Location Address
First Line	:	767 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-8553
Country	:	US
Telephone Number	:	212-751-6652
Fax Number	:

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

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	02/27/2019

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Directions to “ JAWAD DANIEL OD” Practice Location

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