Provider Demographics
NPI:1407881337
Name:DURANTE, DANIEL MICHAEL (OD,PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MICHAEL
Last Name:DURANTE
Suffix:
Gender:M
Credentials:OD,PA
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:MICHAEL
Other - Last Name:DURANTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD,PA
Mailing Address - Street 1:3468 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4440
Mailing Address - Country:US
Mailing Address - Phone:772-692-2020
Mailing Address - Fax:
Practice Address - Street 1:3468NWFEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4440
Practice Address - Country:US
Practice Address - Phone:772-692-3348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1164638078OtherOPTICAL DISPENSARY NPI#
FL1407881337OtherDOCTORS NPI # FOR MEDICAL BILLING
FL620289600Medicaid
FL620289600Medicaid
FL1407881337OtherDOCTORS NPI # FOR MEDICAL BILLING