Provider Demographics
NPI:1134859960
Name:DANIELS, JASMINE (ABO, LDO)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:ABO, LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 S IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3420
Mailing Address - Country:US
Mailing Address - Phone:843-292-0401
Mailing Address - Fax:843-292-0403
Practice Address - Street 1:2014 S IRBY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3420
Practice Address - Country:US
Practice Address - Phone:843-292-0401
Practice Address - Fax:843-292-0403
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1319156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician