Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | DO4769 | FL |
N | 156FX1101X | Ophthalmic Assistant | DO4769 | FL |
Y | 156FX1800X | Optician | DO4769 | FL |
NPI | 1649260894 |
---|---|
Provider Name | Mr. Daniel G Acosta |
First Address | Fort Myers, FL 33912-8125 |
Second Address | Fort Myers, FL 33912-4348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 17/03/2018 |