Provider Demographics
NPI:1215022181
Name:VALENTINE, DANIEL C (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:VALENTINE
Suffix:
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 1:1360 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9066
Mailing Address - Country:US
Mailing Address - Phone:941-488-2020
Mailing Address - Fax:941-484-2200
Practice Address - Street 1:16970 SAN CARLOS BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-1225
Practice Address - Country:US
Practice Address - Phone:239-466-2010
Practice Address - Fax:239-466-2015
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0PC2134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
19781AMedicare ID - Type Unspecified
U22638Medicare UPIN
FL5285190001Medicare NSC