Provider Demographics
NPI:1255658258
Name:DR DANIEL A PAUL OD INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR DANIEL A PAUL OD INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-627-7518
Mailing Address - Street 1:12530 10TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3520
Mailing Address - Country:US
Mailing Address - Phone:909-627-7518
Mailing Address - Fax:
Practice Address - Street 1:12530 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3520
Practice Address - Country:US
Practice Address - Phone:909-627-7518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0085620Medicaid
CAU31759Medicare UPIN
CASD0085620Medicaid