Provider Demographics
NPI:1508041039
Name:J DANIEL PENICK INC
Entity Type:Organization
Organization Name:J DANIEL PENICK INC
Other - Org Name:DALLAS EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PENICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-692-1901
Mailing Address - Street 1:6500 GREENVILLE AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1014
Mailing Address - Country:US
Mailing Address - Phone:214-692-1901
Mailing Address - Fax:214-692-1930
Practice Address - Street 1:6500 GREENVILLE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1014
Practice Address - Country:US
Practice Address - Phone:214-692-1901
Practice Address - Fax:214-692-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0187OT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty