Provider Demographics
NPI:1710495957
Name:DANIEL & MAX LLC
Entity Type:Organization
Organization Name:DANIEL & MAX LLC
Other - Org Name:STANTON OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE/OPERATIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-612-4531
Mailing Address - Street 1:3801 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4140
Mailing Address - Country:US
Mailing Address - Phone:561-275-2020
Mailing Address - Fax:561-275-2030
Practice Address - Street 1:1801 E CENTRAL TEXAS EXPY STE 8
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5328
Practice Address - Country:US
Practice Address - Phone:254-449-9586
Practice Address - Fax:561-828-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty