Provider Demographics
NPI:1952718728
Name:DANIEL M. DURANTE, ODPA
Entity Type:Organization
Organization Name:DANIEL M. DURANTE, ODPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DURANTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:772-692-2020
Mailing Address - Street 1:3468 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4440
Mailing Address - Country:US
Mailing Address - Phone:772-692-2020
Mailing Address - Fax:772-692-2844
Practice Address - Street 1:3468 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4440
Practice Address - Country:US
Practice Address - Phone:772-692-2020
Practice Address - Fax:772-692-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407881337OtherNPI 1
FL1164638140Medicaid
1407881337OtherNPI 1
1164638078Medicare NSC