Healthcare Provider Details

I. General information

NPI: 1093719775
Provider Name (Legal Business Name): DANIEL J BEHN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 38TH AVE N
ST PETERSBURG FL
33713-1926
US

IV. Provider business mailing address

PO BOX 162264
ALTAMONTE SPRINGS FL
32716-2264
US

V. Phone/Fax

Practice location:
  • Phone: 727-822-4287
  • Fax: 727-822-1086
Mailing address:
  • Phone: 941-792-2020
  • Fax: 727-822-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC3210
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: