Healthcare Provider Details

I. General information

NPI: 1699778084
Provider Name (Legal Business Name): DANIELLE GARDNER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N HIGHWAY 67
MIDLOTHIAN TX
76065-8000
US

IV. Provider business mailing address

PO BOX 1870
MIDLOTHIAN TX
76065-1015
US

V. Phone/Fax

Practice location:
  • Phone: 972-775-5300
  • Fax: 972-775-5314
Mailing address:
  • Phone: 713-376-3264
  • Fax: 972-775-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6582TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: