Healthcare Provider Details

I. General information

NPI: 1942059209
Provider Name (Legal Business Name): DANIEL MAX & MARC ANDREA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 W I 240 SERVICE RD STE E
OKLAHOMA CITY OK
73159-4144
US

IV. Provider business mailing address

1615 S CONGRESS AVE STE 105
DELRAY BEACH FL
33445-6326
US

V. Phone/Fax

Practice location:
  • Phone: 405-930-3400
  • Fax: 405-930-3401
Mailing address:
  • Phone: 561-208-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIRSTEN PIPHER CANTRELL
Title or Position: MANAGER OF HEALTH SERVICES
Credential:
Phone: 561-208-8464