Provider Demographics
NPI:1437427010
Name:DANIELLE GARDNER O.D., P.A.
Entity Type:Organization
Organization Name:DANIELLE GARDNER O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-775-5300
Mailing Address - Street 1:PO BOX 1870
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-1870
Mailing Address - Country:US
Mailing Address - Phone:972-775-5300
Mailing Address - Fax:972-775-5314
Practice Address - Street 1:400 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-8000
Practice Address - Country:US
Practice Address - Phone:972-775-5300
Practice Address - Fax:972-775-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6582TG261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01314Medicare UPIN