MEDICARE: GAYLE DANIELS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5343T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447252374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE DANIELS OD

Provider Business Mailing Address
First Line	:	2440 JACKSBORO HWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-2201
Country	:	US
Telephone Number	:	817-626-3721
Fax Number	:	817-626-2006

Provider Business Practice Location Address
First Line	:	2440 JACKSBORO HWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-2201
Country	:	US
Telephone Number	:	817-626-3721
Fax Number	:	817-626-2006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	08/09/2016

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