Basic Information
| Provider Information | |||||||||
| NPI: | 1306839535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DARNELL | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | BART | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2393 SCHUST RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486031334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897932820 | ||||||||
| FaxNumber: | 9897551463 | ||||||||
| Practice Location | |||||||||
| Address1: | 1671 E US 23 | ||||||||
| Address2: | |||||||||
| City: | EAST TAWAS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487309302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893624401 | ||||||||
| FaxNumber: | 9893628141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | DD003811 | MI | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 180G310710 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 38-2334055 | 01 | TAX ID - GROUP | OTHER | 3484042 | 05 | MI | MEDICAID |