Healthcare Provider Details

I. General information

NPI: 1891215489
Provider Name (Legal Business Name): RAUL DANIELS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 02/22/2020
Certification Date: 02/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11915 ATLANTIC AVE
RICHMOND HILL NY
11418-3216
US

IV. Provider business mailing address

266 E 37TH ST
BROOKLYN NY
11203-4006
US

V. Phone/Fax

Practice location:
  • Phone: 718-805-0700
  • Fax: 718-805-2269
Mailing address:
  • Phone: 347-968-6603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008588
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: