Provider Demographics
NPI:1811247083
Name:DALY, JOANNA (OD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16750 S TOWNSEND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5410
Mailing Address - Country:US
Mailing Address - Phone:970-249-0841
Mailing Address - Fax:970-240-7317
Practice Address - Street 1:16750 S TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5410
Practice Address - Country:US
Practice Address - Phone:970-240-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist