Provider Demographics
NPI:1114107059
Name:HORVATH, DAN (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:HORVATH
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:MR
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:HORVATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED OPTICIAN
Mailing Address - Street 1:401 E BELL RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2300
Mailing Address - Country:US
Mailing Address - Phone:602-375-1041
Mailing Address - Fax:602-375-7901
Practice Address - Street 1:401 E BELL RD
Practice Address - Street 2:SUITE 24
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2300
Practice Address - Country:US
Practice Address - Phone:602-375-1041
Practice Address - Fax:602-375-7901
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ712156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician