Healthcare Provider Details

I. General information

NPI: 1912212960
Provider Name (Legal Business Name): MACARIUS, MAX & DANIEL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2010
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 W GLEN AVE
PEORIA IL
61614-4533
US

IV. Provider business mailing address

3801 S CONGRESS AVE
PALM SPRINGS FL
33461-4140
US

V. Phone/Fax

Practice location:
  • Phone: 309-966-1236
  • Fax: 561-828-8367
Mailing address:
  • Phone: 561-275-2020
  • Fax: 561-275-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DANIEL STANTON
Title or Position: CEO
Credential:
Phone: 561-275-2020