Provider Demographics
NPI:1275717290
Name:DANIEL GIOVAGNOLI, O.D.
Entity Type:Organization
Organization Name:DANIEL GIOVAGNOLI, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOVAGNOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-328-0365
Mailing Address - Street 1:PO BOX 4405
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-4405
Mailing Address - Country:US
Mailing Address - Phone:970-328-0365
Mailing Address - Fax:
Practice Address - Street 1:201 GOLDEN EAGLE
Practice Address - Street 2:UNIT A2
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-4405
Practice Address - Country:US
Practice Address - Phone:970-328-0365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 1437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803205Medicare PIN