Provider Demographics
NPI:1437682374
Name:DANIELS OPTOMETRIC SERVICES, LLC
Entity Type:Organization
Organization Name:DANIELS OPTOMETRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:BANKS
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-398-3384
Mailing Address - Street 1:8671 TARA LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-8242
Mailing Address - Country:US
Mailing Address - Phone:334-387-2020
Mailing Address - Fax:334-387-2019
Practice Address - Street 1:2080 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3599
Practice Address - Country:US
Practice Address - Phone:334-387-2020
Practice Address - Fax:334-387-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-827-TA-355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty