Provider Demographics
NPI:1275690307
Name:KENNETH DANIELS, O.D., P.C.
Entity Type:Organization
Organization Name:KENNETH DANIELS, O.D., P.C.
Other - Org Name:HOPEWELL EYE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-466-0055
Mailing Address - Street 1:PO BOX 3560
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08543-3560
Mailing Address - Country:US
Mailing Address - Phone:609-514-0663
Mailing Address - Fax:
Practice Address - Street 1:84 E BROAD ST
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08525-1820
Practice Address - Country:US
Practice Address - Phone:609-466-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00491300152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6296807Medicaid
NJ127898Medicare PIN