Individual
DANIELLE NICOLE LICHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
868 WALKER AVE APT 1, OAKLAND, CA 94610-2033
(925) 413-3110
Mailing address
868 WALKER AVE APT 1, OAKLAND, CA 94610-2033
(925) 413-3110
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
34566
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
05/28/2020
Last updated
07/08/2020
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