Provider Demographics
NPI:1619041506
Name:DESRIVIERES, DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:DESRIVIERES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BIRCH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-9546
Mailing Address - Country:US
Mailing Address - Phone:973-676-8113
Mailing Address - Fax:
Practice Address - Street 1:32 N DAY ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3609
Practice Address - Country:US
Practice Address - Phone:973-676-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA04844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1972778413Other1148-1150 SPRINGFIELD AVE
NJ1548431091Other982 BROAD NPI
NJ1194996645Other444 WILLIAMS
NJ1235300799Other37 N DAY
NJ1619148160Other516 BERGEN
NJ1740345693Other741 BROADWAY
NJ1932370483Other101 LUDLOW
NJ1063683258Other751 NPI
NJ1063683258Other751 NPI
NJ1235300799Other37 N DAY