Healthcare Provider Details

I. General information

NPI: 1720384498
Provider Name (Legal Business Name): DANIELLE R GLOSTER MORRIS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 E PLEASANT RUN RD STE A
DESOTO TX
75115-4200
US

IV. Provider business mailing address

1233 E PLEASANT RUN RD STE A
DESOTO TX
75115-4200
US

V. Phone/Fax

Practice location:
  • Phone: 972-223-2020
  • Fax: 972-228-1860
Mailing address:
  • Phone: 972-223-2020
  • Fax: 972-223-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7670TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: