Provider Demographics
NPI:1154903086
Name:GRAHAM, DANIELLE N
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:N
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 S ROSE PT
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-6307
Mailing Address - Country:US
Mailing Address - Phone:352-422-4712
Mailing Address - Fax:
Practice Address - Street 1:2637 E GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3216
Practice Address - Country:US
Practice Address - Phone:352-637-5180
Practice Address - Fax:352-423-1410
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO7476156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician