Healthcare Provider Details

I. General information

NPI: 1114218997
Provider Name (Legal Business Name): MACARIUS, MAX & DANIEL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 MADISON AVE
FAIR OAKS CA
95628-3309
US

IV. Provider business mailing address

3081 S. CONGRESS AVENUE
PALM SPRINGS FL
33461
US

V. Phone/Fax

Practice location:
  • Phone: 916-863-1534
  • Fax: 561-828-8367
Mailing address:
  • Phone: 561-275-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11554
License Number StateCA

VIII. Authorized Official

Name: MR. DANIEL STANTON
Title or Position: CEO
Credential:
Phone: 561-275-2001