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NPI Code Detail

MEDICARE: J DANIEL PENICK INC

MEDICARE: J DANIEL PENICK INC
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
1152W00000XOptometrist0187OTTX

General Provider Information

NPI Number : 1508041039
Entity Type Code : Organization
Provider Name (Legal Business Name) : J DANIEL PENICK INC
Provider Business Mailing Address
First Line : 6500 GREENVILLE AVE
Second Line : SUITE 150
City : DALLAS
State : TX
Zip : 75206-1014
Country : US
Telephone Number : 214-692-1901
Fax Number : 214-692-1930
Provider Business Practice Location Address
First Line : 6500 GREENVILLE AVE
Second Line : SUITE 150
City : DALLAS
State : TX
Zip : 75206-1014
Country : US
Telephone Number : 214-692-1901
Fax Number : 214-692-1930
Authorized Official
Title or Position : PROVIDER/PROPRIETOR
Name : DR. JAMES DANIEL PENICK
Credential : OD
Telephone Number : 214-692-1901
Provider Enumeration Date : 01/03/2008
Last Update Date : 01/22/2010

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Directions to “J DANIEL PENICK INC ” Practice Location

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