Provider Demographics
NPI:1295707222
Name:VARGOVICK, DANIEL JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:VARGOVICK
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 1:23342 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3102
Mailing Address - Country:US
Mailing Address - Phone:248-477-1616
Mailing Address - Fax:
Practice Address - Street 1:23342 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3102
Practice Address - Country:US
Practice Address - Phone:248-477-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900F367300OtherBCBS
MI0M85680OtherMEDICARE PLUS BLUE
MI900F367300OtherBLUE CARE NETWORK
MIU71684Medicare UPIN
MI900F367300OtherBLUE CARE NETWORK