Provider Demographics
NPI:1902971997
Name:MARKLEY, DANIEL L (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:MARKLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12606 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2447
Mailing Address - Country:US
Mailing Address - Phone:810-694-3652
Mailing Address - Fax:810-694-0963
Practice Address - Street 1:12606 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2447
Practice Address - Country:US
Practice Address - Phone:810-694-3652
Practice Address - Fax:810-694-0963
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0994958OtherHEALTH PLUS OF MI
MI900B563850OtherBCBS
MI4861189Medicaid
U76098Medicare UPIN
MIB56385007Medicare PIN
MI0994958OtherHEALTH PLUS OF MI