Pridemore, Daniel Carl
Pridemore, Daniel Carl is an individual health care provider with primary practice located at 2761 S 108Th St , West Allis WI 53227-3232. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Pridemore, Daniel Carl can be contacted via phone (414) 321-2425.Contact Information
Primary practice address
2761 S 108Th St
West Allis WI 53227-3232
Phone: (414) 321-2425
Fax: (414) 321-4647
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 3270-35 | Wisconsin |
Profile Details
| NPI number | 1104189877 |
|---|---|
| LBN Legal business name | Pridemore, Daniel Carl |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 19th, 2012 |
| Last updated | Jun 19th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104189877 | NPPES |
| Wisconsin | MEDICAID | 020677066 |
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