Provider Demographics
NPI:1184808800
Name:DANIEL AND DAVIS OPTOMETRY, INC.
Entity type:Organization
Organization Name:DANIEL AND DAVIS OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-434-3314
Mailing Address - Street 1:3144 EL CAMINO REAL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2194
Mailing Address - Country:US
Mailing Address - Phone:760-434-3314
Mailing Address - Fax:760-434-5624
Practice Address - Street 1:3144 EL CAMINO REAL
Practice Address - Street 2:SUITE 202
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2194
Practice Address - Country:US
Practice Address - Phone:760-434-3314
Practice Address - Fax:760-434-5624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR1136152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWY016BMedicare PIN