MEDICARE: DANIEL D MICHAEL 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	1664	GA

General Provider Information

NPI Number	:	1821090077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL D MICHAEL OD

Provider Business Mailing Address
First Line	:	4 HARDING CT
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-5432
Country	:	US
Telephone Number	:	706-771-9403
Fax Number	:

Provider Business Practice Location Address
First Line	:	EXCHANGE EYECARE
Second Line	:	271 3RD AVE
City	:	FORT GORDON
State	:	GA
Zip	:	30905
Country	:	US
Telephone Number	:	706-771-9403
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/02/2026

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