Provider Demographics
NPI:1013059096
Name:ROY, DANIEL P (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:ROY
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 1:1110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3612
Mailing Address - Country:US
Mailing Address - Phone:207-324-6281
Mailing Address - Fax:207-324-7143
Practice Address - Street 1:1110 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3612
Practice Address - Country:US
Practice Address - Phone:207-324-6281
Practice Address - Fax:207-324-7143
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME114270000Medicaid
MET31694Medicare UPIN
ME703790Medicare ID - Type Unspecified
ME114270000Medicaid