Healthcare Provider Details

I. General information

NPI: 1750320404
Provider Name (Legal Business Name): DANIEL JOSEPH SULLIVAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BLOWING ROCK RD SUITE 1A
BOONE NC
28607-4883
US

IV. Provider business mailing address

1180 BLOWING ROCK RD SUITE 1A
BOONE NC
28607-4883
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-2020
  • Fax: 828-264-8918
Mailing address:
  • Phone: 828-264-2020
  • Fax: 828-264-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNC1778
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: