Provider Demographics
NPI:1114195336
Name:DANNY W. NEITZ, O.D.
Entity Type:Organization
Organization Name:DANNY W. NEITZ, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:W
Authorized Official - Last Name:NEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-948-7120
Mailing Address - Street 1:803 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-2105
Mailing Address - Country:US
Mailing Address - Phone:610-948-7120
Mailing Address - Fax:610-948-4433
Practice Address - Street 1:803 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-2105
Practice Address - Country:US
Practice Address - Phone:610-948-7120
Practice Address - Fax:610-948-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-G001021332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT88982Medicare UPIN
PA0350940001Medicare NSC