MEDICARE: GAYLE Y. DANIELS, PC

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	5343TG	TX

General Provider Information

NPI Number	:	1497993638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAYLE Y. DANIELS, PC

Provider Business Mailing Address
First Line	:	2440 JACKSBORO HWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-2201
Country	:	US
Telephone Number	:	817-626-3723
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	:	817-626-3723
Fax Number	:	817-626-2006

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GAYLE DANIELS
Credential	:	O.D.
Telephone Number	:	817-626-3723

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	08/30/2016

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