Provider Demographics
NPI:1568636090
Name:RICHARD S. DANIEL, O.D., P.A.
Entity Type:Organization
Organization Name:RICHARD S. DANIEL, O.D., P.A.
Other - Org Name:DANIEL VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SHAFFER
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-864-6070
Mailing Address - Street 1:161 WESTWOOD SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1521
Mailing Address - Country:US
Mailing Address - Phone:910-864-6070
Mailing Address - Fax:910-864-4036
Practice Address - Street 1:161 WESTWOOD SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1521
Practice Address - Country:US
Practice Address - Phone:910-864-6070
Practice Address - Fax:910-864-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09220OtherBLUE CROSS BLUE SHIELD
NC8909220Medicaid
NC=========OtherTRICARE
NC1188180001Medicare NSC
NC246423BMedicare PIN
NCT64958Medicare UPIN