Provider Demographics
NPI:1386493641
Name:DANIEL MAX & MARC ANDREA LLC
Entity type:Organization
Organization Name:DANIEL MAX & MARC ANDREA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:PIPHER
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-208-8464
Mailing Address - Street 1:1615 S CONGRESS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6326
Mailing Address - Country:US
Mailing Address - Phone:561-208-8464
Mailing Address - Fax:
Practice Address - Street 1:6310 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4298
Practice Address - Country:US
Practice Address - Phone:405-930-3700
Practice Address - Fax:405-930-3701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL MAX & MARC ANDREA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier