Healthcare Provider Details

I. General information

NPI: 1780148205
Provider Name (Legal Business Name): DANIEL & MAX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W TOWN SQUARE WAY STE 700
OAK CREEK WI
53154-6811
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 414-563-0551
  • Fax: 561-828-8367
Mailing address:
  • Phone: 561-208-8464
  • Fax: 561-275-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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