Provider Demographics
NPI:1770006736
Name:BRENNAN, DANIEL M (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:BRENNAN
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 1:1350 N LAKE SHORE DR APT 503
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5123
Mailing Address - Country:US
Mailing Address - Phone:847-849-0886
Mailing Address - Fax:
Practice Address - Street 1:225 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7757
Practice Address - Country:US
Practice Address - Phone:312-819-0199
Practice Address - Fax:312-819-0220
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist