Provider Demographics
NPI:1821404302
Name:BRINCHMAN, DANIEL JUEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JUEL
Last Name:BRINCHMAN
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 1:5701 S MO PAC EXPY APT 1123
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1444
Mailing Address - Country:US
Mailing Address - Phone:619-823-8777
Mailing Address - Fax:
Practice Address - Street 1:3908 FAR WEST BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2994
Practice Address - Country:US
Practice Address - Phone:512-343-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8501TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist