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General NPI Number Information
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NPI Number | 1619041506
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Entity Type | Individual
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Provider Name | DANIEL DESRIVIERES O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 32 N DAY ST
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City | ORANGE
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State | NJ
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Zip | 07050-3609
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Country | US
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Telephone | 973-676-8113
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Fax |
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Provider Business Mailing Address
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Address Line | 33 BIRCH RIDGE RD
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City | HARDWICK
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State | NJ
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Zip | 07825-9546
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Country | US
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Telephone | 973-676-8113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OA04844
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License Number State | NJ
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