1376858308 NPI number — MACARIUS & DANIEL

Table of content: (NPI 1376858308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376858308 NPI number — MACARIUS & DANIEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MACARIUS & DANIEL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STANTON OPTICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376858308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1615 S CONGRESS AVE STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33445-6326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-275-2020
Provider Business Mailing Address Fax Number:
561-275-2002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
434 GAMMON PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53719-1090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-237-3976
Provider Business Practice Location Address Fax Number:
561-828-8367
Provider Enumeration Date:
08/14/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CANTRELL
Authorized Official First Name:
KIRSTEN
Authorized Official Middle Name:
PIPHER
Authorized Official Title or Position:
MANAGER OF HEALTH SERVICES
Authorized Official Telephone Number:
561-208-8464

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  316335 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)