Healthcare Provider Details

I. General information

NPI: 1306032362
Provider Name (Legal Business Name): DANIEL JOSEPH EAGAN JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2007
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5116 HEATH RD
AUBURN AL
36830-4201
US

IV. Provider business mailing address

5116 HEATH RD
AUBURN AL
36830-4201
US

V. Phone/Fax

Practice location:
  • Phone: 334-468-0698
  • Fax: 334-502-1453
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-B57-TA-770
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberS-B57-TA-770
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberS-B57-TA-770
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberS-B57-TA-770
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberS-B57-TA-770
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberS-B57-TA-770
License Number StateAL
# 7
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberS-B57-TA-770
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: