Provider Demographics
NPI:1063850360
Name:DANIAL, EFFAT (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:EFFAT
Middle Name:
Last Name:DANIAL
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 OCEAN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1633
Mailing Address - Country:US
Mailing Address - Phone:415-334-2022
Mailing Address - Fax:
Practice Address - Street 1:2645 OCEAN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1633
Practice Address - Country:US
Practice Address - Phone:415-334-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL6635156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician