Provider Demographics
NPI:1326539081
Name:LORENZO, DANIEL DARIO (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DARIO
Last Name:LORENZO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 KENILWORTH AVE, 5FLOOR E-14,
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1333
Mailing Address - Country:US
Mailing Address - Phone:301-277-6060
Mailing Address - Fax:301-277-6061
Practice Address - Street 1:6811 KENILWORTH AVE FL 5
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1333
Practice Address - Country:US
Practice Address - Phone:301-277-6060
Practice Address - Fax:301-277-6061
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD82-3543594Medicaid
MD$$$$$$$$$Medicaid