Provider Demographics
NPI:1700015609
Name:BELAJIC, DANIEL ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALAN
Last Name:BELAJIC
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 1:333 S AUBURN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-9776
Mailing Address - Country:US
Mailing Address - Phone:530-885-6241
Mailing Address - Fax:530-885-0144
Practice Address - Street 1:333 S AUBURN ST STE 1
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:CA
Practice Address - Zip Code:95713-9776
Practice Address - Country:US
Practice Address - Phone:530-885-6241
Practice Address - Fax:530-885-0144
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB469AMedicare UPIN