Provider Demographics
NPI:1710337571
Name:PURVIS, DANIEL WESLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WESLEY
Last Name:PURVIS
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 1:12422 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6392
Mailing Address - Country:US
Mailing Address - Phone:314-579-0909
Mailing Address - Fax:
Practice Address - Street 1:2464 W MAIN ST
Practice Address - Street 2:STE 3
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-6413
Practice Address - Country:US
Practice Address - Phone:334-792-2020
Practice Address - Fax:334-712-2020
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR269-TA-B39152W00000X
MO2016019301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty