Provider Demographics
NPI:1699781682
Name:PAUL, DANIEL AUSTIN (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:AUSTIN
Last Name:PAUL
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 1:12530 10TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-627-7518
Mailing Address - Fax:909-591-1380
Practice Address - Street 1:12530 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-627-7518
Practice Address - Fax:909-591-1380
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0085620Medicaid
SD0085620Medicare ID - Type Unspecified
U31759Medicare UPIN