Healthcare Provider Details

I. General information

NPI: 1760925226
Provider Name (Legal Business Name): DANIEL R CONRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N ALLEN DR SUITE 107
ALLEN TX
75013-2555
US

IV. Provider business mailing address

400 N ALLEN DR SUITE 107
ALLEN TX
75013-2555
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-9812
  • Fax: 972-747-9814
Mailing address:
  • Phone: 972-747-9812
  • Fax: 972-747-9814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: