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General NPI Number Information
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NPI Number | 1912087636
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Entity Type | Individual
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Provider Name | BRIAN L DANIELS O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 331 MAINE ST., SUITE 1
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City | BRUNSWICK
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State | ME
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Zip | 04011-3359
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Country | US
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Telephone | 207-725-2161
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Fax |
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Provider Business Mailing Address
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Address Line | 8 HAYWOOD LN
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City | BRUNSWICK
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State | ME
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Zip | 04011-7124
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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 |
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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 | OPT661
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License Number State | ME
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