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General NPI Number Information
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NPI Number | 1033488085
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Entity Type | Individual
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Provider Name | DARRYL GLEN JOSEPH OD
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Gender | Male
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 844 S FEDERAL HWY
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-5752
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Country | US
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Telephone | 561-614-8267
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Fax | 954-421-7278
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Provider Business Mailing Address
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Address Line | 21533 HALSTEAD DR
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City | BOCA RATON
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State | FL
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Zip | 33428-4844
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Country | US
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Telephone | 561-451-9914
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Fax | 561-451-9914
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3971
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License Number State | FL
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