Provider Demographics
NPI:1316731300
Name:DIBUCCHIANICO, DANIEL ALEXANDER (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:DIBUCCHIANICO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NW 17TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1134
Mailing Address - Country:US
Mailing Address - Phone:305-243-2020
Mailing Address - Fax:305-326-6114
Practice Address - Street 1:900 NW 17TH ST STE 6
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1134
Practice Address - Country:US
Practice Address - Phone:305-243-2020
Practice Address - Fax:305-326-6114
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOPC6755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program