Provider Demographics
NPI:1417097734
Name:DAVID, DANNY MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:MICHAEL
Last Name:DAVID
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 FREEDOM CT
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1979
Mailing Address - Country:US
Mailing Address - Phone:847-414-4233
Mailing Address - Fax:
Practice Address - Street 1:520 E GOLF RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4442
Practice Address - Country:US
Practice Address - Phone:847-781-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist