Individual
DR. LANCE DANIEL I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4201 N SHILOH DR, FAYETTEVILLE, AR 72703-5180
(479) 444-8704
Mailing address
1100 S AMITY RD STE A, CONWAY, AR 72032-8106
(501) 388-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2371
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117012722
OPTOMETRY
AR
05
—
117012722
—
AR
01
—
710744825
TAX ID
AR
Enumeration date
02/09/2007
Last updated
07/15/2021
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