Provider Demographics
NPI:1336335843
Name:SIDA, DANIEL (CERTIFIED OPTICIAN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SIDA
Suffix:
Gender:M
Credentials:CERTIFIED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 GOLDEN KEY CIR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5820
Mailing Address - Country:US
Mailing Address - Phone:915-593-6801
Mailing Address - Fax:915-593-1419
Practice Address - Street 1:1200 GOLDEN KEY CIR
Practice Address - Street 2:SUITE 160
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5820
Practice Address - Country:US
Practice Address - Phone:915-593-6801
Practice Address - Fax:915-593-1419
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10526156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5314530001Medicare NSC