Provider Demographics
NPI:1558853838
Name:HEAD, DANNY LEE JR (OD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:LEE
Last Name:HEAD
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:2554 N ASSOCIATED RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4375
Mailing Address - Country:US
Mailing Address - Phone:626-327-3008
Mailing Address - Fax:
Practice Address - Street 1:1 MILLS CIR STE 516
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5211
Practice Address - Country:US
Practice Address - Phone:626-327-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33929-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist