Individual
DR. DANIEL H MALLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1409 N NORMA ST, RIDGECREST, CA 93555-2510
(760) 446-5555
(790) 446-2905
Mailing address
1409 N NORMA ST, RIDGECREST, CA 93555-2510
(760) 446-5555
(790) 446-2905
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT7267TLG
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
953703868 93555 A001
TRICARE
CA
05
—
SD0072671
—
CA
Enumeration date
06/09/2005
Last updated
09/08/2022
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