Healthcare Provider Details

I. General information

NPI: 1275309759
Provider Name (Legal Business Name): DANIEL & MAX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 OKEECHOBEE RD
FORT PIERCE FL
34947
US

IV. Provider business mailing address

PO BOX 744351
ATLANTA GA
30374-4351
US

V. Phone/Fax

Practice location:
  • Phone: 877-350-3399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: KIRSTEN PIPHER CANTRELL
Title or Position: MANAGER
Credential:
Phone: 561-208-8464