Provider Demographics
NPI:1003849456
Name:MEDEMA, DANIEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:MEDEMA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:814 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3435
Mailing Address - Country:US
Mailing Address - Phone:630-881-3339
Mailing Address - Fax:847-358-4972
Practice Address - Street 1:279 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-5326
Practice Address - Country:US
Practice Address - Phone:847-358-4970
Practice Address - Fax:847-358-4972
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0468031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist