Provider Demographics
NPI:1093719775
Name:BEHN, DANIEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:BEHN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 38TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-1926
Mailing Address - Country:US
Mailing Address - Phone:727-822-4287
Mailing Address - Fax:727-822-1086
Practice Address - Street 1:1601 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-1926
Practice Address - Country:US
Practice Address - Phone:727-822-4287
Practice Address - Fax:727-822-1086
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3210152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2793XOtherMEDICARE PTAN
FLU75968Medicare UPIN