Provider Demographics
NPI:1356535181
Name:DAUPHIN OPTICAL
Entity type:Organization
Organization Name:DAUPHIN OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:RENCHER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:251-344-8691
Mailing Address - Street 1:108 W I65 SERVICE RD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-5902
Mailing Address - Country:US
Mailing Address - Phone:251-344-8691
Mailing Address - Fax:
Practice Address - Street 1:108 W I65 SERVICE RD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-5902
Practice Address - Country:US
Practice Address - Phone:251-344-8691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier