Individual
DR. DANIEL CARL PRIDEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2761 S 108TH ST, WEST ALLIS, WI 53227-3232
(414) 321-2425
(414) 321-4647
Mailing address
2761 S 108TH ST, WEST ALLIS, WI 53227-3232
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3270-35
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020677066
—
WI
Enumeration date
06/19/2012
Last updated
06/19/2012
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