Provider Demographics
NPI:1003957374
Name:DANIEL, LANCE I (OD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:
Last Name:DANIEL
Suffix:I
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 1:1100 S AMITY RD STE A
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8106
Mailing Address - Country:US
Mailing Address - Phone:501-388-2020
Mailing Address - Fax:
Practice Address - Street 1:4201 N SHILOH DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5180
Practice Address - Country:US
Practice Address - Phone:479-444-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR710744825OtherTAX ID
AR117012722Medicaid
AR117012722OtherOPTOMETRY
ART90729Medicare UPIN
AR120008722Medicaid