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General NPI Number Information
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NPI Number | 1720022585
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Entity Type | Organization
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Legal Business Name | DANIEL D MICHAEL OD
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 3450 WRIGHTSBORO RD
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City | AUGUSTA
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State | GA
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Zip | 30909-2516
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Country | US
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Telephone | 706-731-0698
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 WRIGHTSBORO RD #B
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City | AUGUSTA
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State | GA
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Zip | 30909-2516
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Country | US
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Telephone | 706-731-0698
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL D MICHAEL
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Credential | OD
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Telephone | 706-731-0698
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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 | 1664
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License Number State | GA
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