Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 592 | AZ |
NPI | 1003827015 |
---|---|
Provider Name | Dr. Lincoln Joseph Daynes |
First Address | Sierra Vista, AZ 85635-1758 |
Second Address | Sierra Vista, AZ 85635-1758 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 05/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T67107 | (02) | AZ |