Provider Demographics
NPI:1528149374
Name:VANLANINGHAM, DANIEL R (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:VANLANINGHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BRIARCREST DR
Mailing Address - Street 2:STE 106
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5000
Mailing Address - Country:US
Mailing Address - Phone:979-774-5400
Mailing Address - Fax:
Practice Address - Street 1:2200 BRIARCREST DR
Practice Address - Street 2:STE 106
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5000
Practice Address - Country:US
Practice Address - Phone:979-774-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5628T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU73962Medicare UPIN
TX00 303TMedicare ID - Type UnspecifiedMEDICARE #