Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC5047 | FL |
NPI | 1013397231 |
---|---|
Provider Name | Dr. Madeline Rose Dau |
First Address | Saint Johns, FL 32259-4090 |
Second Address | Saint Johns, FL 32259-4090 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2015 |
Last Update Date | 04/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015029700 | (05) | FL |