1669454187 NPI number — DR. DANIEL K GIFT O.D.

Table of content: DR. DANIEL K GIFT O.D. (NPI 1669454187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669454187 NPI number — DR. DANIEL K GIFT O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIFT
Provider First Name:
DANIEL
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669454187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
423 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17842-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-837-0112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17842-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-837-0112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OE004310T , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 391434 . This is a "NATIONAL VISION ADMIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 13601 . This is a "SPECTERA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: GI287846 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30085 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4310 . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA 4310 . This is a "EYEMED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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