Provider Demographics
NPI:1851459945
Name:KING, DANIELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18610 NW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2406
Mailing Address - Country:US
Mailing Address - Phone:305-474-0433
Mailing Address - Fax:305-474-8071
Practice Address - Street 1:18610 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2406
Practice Address - Country:US
Practice Address - Phone:305-474-0433
Practice Address - Fax:305-474-8071
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4147152W00000X
NY007079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist