Individual
DR. DANIELLE J IRVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
309 N FRANKLIN ST, PORT WASHINGTON, WI 53074-1905
(262) 261-5252
Mailing address
1323 E COLORADO ST APT 4, MILWAUKEE, WI 53207-2271
(262) 689-1629
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046010557
IL
152W00000X
Optometrist
Primary
3589-35
WI
152WL0500X
Low Vision Rehabilitation Optometrist
046010557
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010557
—
IL
01
—
502720065
MEDICARE PTAN
IL
Enumeration date
06/22/2012
Last updated
10/21/2019
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