Individual
DR. DANIEL LACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
117 PENSTOCK LN, LAKE KATRINE, NY 12449-5240
(845) 336-6124
Mailing address
117 PENSTOCK LN, LAKE KATRINE, NY 12449-5240
(845) 336-6124
Taxonomy
Speciality
Code
Description
License number
State
152WV0400X
Vision Therapy Optometrist
Primary
TUV003890
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01125268
—
NY
Enumeration date
04/18/2006
Last updated
07/08/2007
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