Provider Demographics
NPI:1255843199
Name:DANIEL T KHONG, OD, APOC
Entity Type:Organization
Organization Name:DANIEL T KHONG, OD, APOC
Other - Org Name:OPTICAL ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:504-466-0271
Mailing Address - Street 1:3409 WILLIAMS BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3879
Mailing Address - Country:US
Mailing Address - Phone:504-466-0271
Mailing Address - Fax:504-466-3011
Practice Address - Street 1:2645 MANHATTAN BLVD STE E2B
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3375
Practice Address - Country:US
Practice Address - Phone:504-309-8619
Practice Address - Fax:504-218-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1185-338T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty