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General NPI Number Information
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NPI Number | 1508041039
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Entity Type | Organization
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Legal Business Name | J DANIEL PENICK INC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | 6500 GREENVILLE AVE SUITE 150
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City | DALLAS
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State | TX
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Zip | 75206-1014
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Country | US
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Telephone | 214-692-1901
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Fax | 214-692-1930
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Provider Business Mailing Address
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Address Line | 6500 GREENVILLE AVE SUITE 150
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City | DALLAS
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State | TX
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Zip | 75206-1014
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Country | US
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Telephone | 214-692-1901
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Fax | 214-692-1930
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Authorized Official
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Title or Position | PROVIDER/PROPRIETOR
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Name | DR. JAMES DANIEL PENICK
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Credential | OD
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Telephone | 214-692-1901
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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 | 0187OT
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License Number State | TX
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