Provider Demographics
NPI:1427388487
Name:SULLIVAN, DANIEL (RO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:RO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2443
Mailing Address - Country:US
Mailing Address - Phone:508-222-5400
Mailing Address - Fax:
Practice Address - Street 1:160 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2443
Practice Address - Country:US
Practice Address - Phone:508-222-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1934156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician