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General NPI Number Information
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NPI Number | 1295201580
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Entity Type | Organization
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Legal Business Name | DANIEL MAX & MARCANDREA, LLC
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Dates
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Enumeration Date | 10/15/2018
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 1309 E. PLEASANT RUN RD
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City | DESOTO
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State | TX
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Zip | 75115
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Country | US
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Telephone | 561-275-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 S CONGRESS AVE
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City | PALM SPRINGS
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State | FL
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Zip | 33461-4140
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Country | US
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Telephone | 561-275-2020
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JACKIE BENNETT
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Credential |
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Telephone | 561-612-4531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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