Healthcare Provider Details

I. General information

NPI: 1134216112
Provider Name (Legal Business Name): DANIEL O OLANREWAJU O.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 G ST STE C00007
JB ANDREWS MD
20762-5677
US

IV. Provider business mailing address

1811 G ST STE C00007
JB ANDREWS MD
20762-5677
US

V. Phone/Fax

Practice location:
  • Phone: 301-735-1393
  • Fax: 512-305-3301
Mailing address:
  • Phone: 301-633-0339
  • Fax: 512-305-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2040
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9112T
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001702
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: