Provider Demographics
NPI:1447271721
Name:PACE, DANIEL WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WAYNE
Last Name:PACE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:70 N MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6101
Mailing Address - Country:US
Mailing Address - Phone:801-292-1408
Mailing Address - Fax:801-292-1966
Practice Address - Street 1:70 N MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6101
Practice Address - Country:US
Practice Address - Phone:801-292-1408
Practice Address - Fax:801-292-1966
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4753319-9934152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQM0000041790OtherALTIUS HEALTH PLANS
UT47533199901001OtherBLUE CROSS BLUE SHIELD
UTU81068Medicare UPIN