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General NPI Number Information
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NPI Number | 1750688826
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Entity Type | Organization
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Legal Business Name | DANIEL EYE CARE INCORPORATED
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 3085 BUFORD HWY
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City | DULUTH
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State | GA
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Zip | 30096-3353
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Country | US
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Telephone | 770-476-3611
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 IDLEWOOD CT
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City | MARIETTA
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State | GA
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Zip | 30062-6604
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTEN DANIEL
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Credential | O.D.
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Telephone | 404-512-9542
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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 | OPT002608
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License Number State | GA
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