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General NPI Number Information
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NPI Number | 1437682374
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Entity Type | Organization
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Legal Business Name | DANIELS OPTOMETRIC SERVICES, LLC
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 2080 BERRYHILL RD
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City | MONTGOMERY
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State | AL
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Zip | 36117-3599
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Country | US
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Telephone | 334-387-2020
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Fax | 334-387-2019
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Provider Business Mailing Address
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Address Line | 8671 TARA LN
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City | AUBURN
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State | AL
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Zip | 36830-8242
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Country | US
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Telephone | 334-387-2020
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Fax | 334-387-2019
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. LISA BANKS DANIEL
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Credential | O.D.
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Telephone | 334-398-3384
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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 | S-827-TA-355
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License Number State | AL
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