Provider Demographics
NPI:1992837199
Name:DAN E MCQUEEN, O.D., P.C.
Entity Type:Organization
Organization Name:DAN E MCQUEEN, O.D., P.C.
Other - Org Name:DR MCQUEEN & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-328-0015
Mailing Address - Street 1:4301 W WILLIAM CANNON, #B210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749
Mailing Address - Country:US
Mailing Address - Phone:512-328-0015
Mailing Address - Fax:512-328-7638
Practice Address - Street 1:4301 W WILLIAM CANNON, #B210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749
Practice Address - Country:US
Practice Address - Phone:512-328-0015
Practice Address - Fax:512-328-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3730T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E84GMedicare ID - Type UnspecifiedMEDICARE GROUP #