Organization
DANIEL MAX & MARC ANDREA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE BENNETT (CREDENTIALING MANAGER)
(561) 612-4531
Entity
Organization
Contact information
Practice address
113 NORTHSIDE DR E, STATESBORO, GA 30458-2185
(561) 275-2020
(561) 828-8367
Mailing address
3801 S CONGRESS AVE, PALM SPRINGS, FL 33461-4140
(561) 275-2020
(561) 828-8367
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
07/19/2019
Last updated
02/17/2021
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