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Individual

DR. DANIEL JOSEPH VIDLAK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1022 NW 6TH STREET, GRANTS PASS, OR 97526
(541) 476-4545
Mailing address
1022 NW 6TH STREET, GRANTS PASS, OR 97526
(541) 476-4545

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2643ATI
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
150462
OR
01
2643ATI
STATE LICENSE
OR
Enumeration date
10/03/2006
Last updated
03/07/2023
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