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General NPI Number Information
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NPI Number | 1427398577
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Entity Type | Organization
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Legal Business Name | DANIEL H. MALLORY, O.D.
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Dates
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Enumeration Date | 02/27/2013
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 1409 N NORMA ST
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City | RIDGECREST
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State | CA
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Zip | 93555-2510
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Country | US
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Telephone | 760-446-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 N NORMA ST
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City | RIDGECREST
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State | CA
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Zip | 93555-2510
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL H MALLORY
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Credential | O.D.
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Telephone | 760-446-5555
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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 |
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License Number State |
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