Healthcare Provider Details

I. General information

NPI: 1003464819
Provider Name (Legal Business Name): DANIEL & MAX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 SHERWOOD WAY # 113
SAN ANGELO TX
76904-9734
US

IV. Provider business mailing address

3801 S CONGRESS AVE
PALM SPRINGS FL
33461-4140
US

V. Phone/Fax

Practice location:
  • Phone: 325-276-3830
  • Fax: 561-828-8367
Mailing address:
  • Phone: 561-433-6009
  • 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: ALISHA JACKSON
Title or Position: SENIOR REVENUE CYCLE MANAGER
Credential:
Phone: 561-208-1591