Provider Demographics
NPI:1891291662
Name:DR DANIEL MULDER OPTOMETRY LLC
Entity Type:Organization
Organization Name:DR DANIEL MULDER OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-525-3922
Mailing Address - Street 1:695 CANARY CIR
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-6511
Mailing Address - Country:US
Mailing Address - Phone:702-490-8614
Mailing Address - Fax:
Practice Address - Street 1:2333 RENO HWY
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-6385
Practice Address - Country:US
Practice Address - Phone:775-525-3922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV926152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty