Individual
DR. DANIEL SCOTT MIRKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
253 BEACH 116TH ST, ROCKAWAY PARK, NY 11694-2102
(718) 634-0005
(718) 474-2003
Mailing address
253 BEACH 116TH ST, ROCKAWAY PARK, NY 11694-2102
(718) 634-0005
(718) 474-2003
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
VUT004688
NY
152WC0802X
Corneal and Contact Management Optometrist
VUT004688
NY
152WP0200X
Pediatric Optometrist
VUT004688
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01126778
—
NY
01
—
1558363630
GROUP MEMBER NPI
—
01
—
DM0C408810
BLUE SHIELD
NY
01
—
G400012756
GROUP MEMBER PTAN
—
01
—
OP90652
AETNA
—
01
—
P824790
OXFORD
—
Enumeration date
06/02/2005
Last updated
10/25/2011
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