Provider Demographics
NPI:1801996822
Name:MORAIS, DANIEL DUTRA (OD)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DUTRA
Last Name:MORAIS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:6126 GREEN JACKET DR APT 1035
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6868
Mailing Address - Country:US
Mailing Address - Phone:817-306-9400
Mailing Address - Fax:817-232-0473
Practice Address - Street 1:1401 N SAGINAW BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-5096
Practice Address - Country:US
Practice Address - Phone:817-306-9400
Practice Address - Fax:817-232-0473
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX6655T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612238Medicare ID - Type Unspecified