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General NPI Number Information
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NPI Number | 1528307873
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Entity Type | Organization
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Legal Business Name | DAYNES OPTICAL INC
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 400 W FRY BLVD STE 9
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-1760
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Country | US
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Telephone | 520-459-1650
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Fax | 520-459-6202
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Provider Business Mailing Address
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Address Line | 400 W FRY BLVD STE 9
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-1760
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Country | US
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Telephone | 520-459-1650
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Fax | 520-459-6202
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LINCOLN JOSEPH DAYNES
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Credential | OD
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Telephone | 520-459-1650
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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 | 592
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License Number State | AZ
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