Provider Demographics
NPI:1356759146
Name:ALLEN, DANIEL J (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:J
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD INC
Mailing Address - Street 1:16306 SIERRA PASS WAY
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-5514
Mailing Address - Country:US
Mailing Address - Phone:909-618-3960
Mailing Address - Fax:
Practice Address - Street 1:3350 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2206
Practice Address - Country:US
Practice Address - Phone:323-268-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist