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General NPI Number Information
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NPI Number | 1063786317
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Entity Type | Organization
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Legal Business Name | DAVID R MCDANIEL OD PA
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 510 W KING ST
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City | KINGS MTN
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State | NC
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Zip | 28086-3310
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Country | US
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Telephone | 704-739-1394
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Fax |
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Provider Business Mailing Address
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Address Line | 510 W KING ST PO BOX 1127
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City | KINGS MTN
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State | NC
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Zip | 28086-3310
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Country | US
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Telephone | 704-739-1394
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. DAVID RONALD MCDANIEL
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Credential | OD
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Telephone | 704-739-1394
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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 | NC0991
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License Number State | NC
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