Provider Demographics
NPI:1720022585
Name:DANIEL D MICHAEL OD
Entity Type:Organization
Organization Name:DANIEL D MICHAEL OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-731-0698
Mailing Address - Street 1:3450 WRIGHTSBORO RD
Mailing Address - Street 2:#B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2516
Mailing Address - Country:US
Mailing Address - Phone:706-731-0698
Mailing Address - Fax:
Practice Address - Street 1:3450 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2516
Practice Address - Country:US
Practice Address - Phone:706-731-0698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU72430Medicare UPIN
GA41ZCDKQMedicare PIN