Provider Demographics
NPI:1114619707
Name:DANIELS, JAMES ROY (LIC OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROY
Last Name:DANIELS
Suffix:
Gender:M
Credentials:LIC OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HANDSOME AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2905
Mailing Address - Country:US
Mailing Address - Phone:631-524-0122
Mailing Address - Fax:
Practice Address - Street 1:85 CROOKED HILL RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5407
Practice Address - Country:US
Practice Address - Phone:631-864-1975
Practice Address - Fax:631-864-2173
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009594-01156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician