Healthcare Provider Details

I. General information

NPI: 1326539081
Provider Name (Legal Business Name): DANIEL DARIO LORENZO OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 KENILWORTH AVE FL 5
RIVERDALE MD
20737-1333
US

IV. Provider business mailing address

6811 KENILWORTH AVE, 5FLOOR E-14,
RIVERDALE MD
20737-1333
US

V. Phone/Fax

Practice location:
  • Phone: 301-277-6060
  • Fax: 301-277-6061
Mailing address:
  • Phone: 301-277-6060
  • Fax: 301-277-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: