Healthcare Provider Details

I. General information

NPI: 1841915584
Provider Name (Legal Business Name): DANIELLE ESLICK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 S US HIGHWAY 41
TERRE HAUTE IN
47802-3791
US

IV. Provider business mailing address

3013 S US HIGHWAY 41
TERRE HAUTE IN
47802-3791
US

V. Phone/Fax

Practice location:
  • Phone: 812-234-4434
  • Fax:
Mailing address:
  • Phone: 812-234-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004366A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: