Provider Demographics
NPI:1225154891
Name:FEDERSPILL, DANIEL J (CTFD OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:FEDERSPILL
Suffix:
Gender:M
Credentials:CTFD OPTICIAN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3100 MERIDIAN PARKE DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9427
Mailing Address - Country:US
Mailing Address - Phone:317-888-9755
Mailing Address - Fax:317-888-9768
Practice Address - Street 1:3100 MERIDIAN PARKE DR
Practice Address - Street 2:SUITE J
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-9427
Practice Address - Country:US
Practice Address - Phone:317-888-9755
Practice Address - Fax:317-888-9768
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN35-1762626156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0615560001Medicare ID - Type Unspecified