Provider Demographics
NPI:1346524774
Name:DANIELSON EYE CARE
Entity Type:Organization
Organization Name:DANIELSON EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DANIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:413-543-5333
Mailing Address - Street 1:1964 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1480
Mailing Address - Country:US
Mailing Address - Phone:413-543-5444
Mailing Address - Fax:413-543-5444
Practice Address - Street 1:1964 BOSTON RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1480
Practice Address - Country:US
Practice Address - Phone:413-543-5444
Practice Address - Fax:413-543-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2602152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110014431AMedicaid
MAW15267Medicare UPIN