Provider Demographics
NPI:1285632927
Name:MACDANIEL, JOHN PRICE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PRICE
Last Name:MACDANIEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13640-0468
Mailing Address - Country:US
Mailing Address - Phone:315-243-3048
Mailing Address - Fax:
Practice Address - Street 1:6157 US ROUTE 20
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084-3404
Practice Address - Country:US
Practice Address - Phone:315-677-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB7993Medicare ID - Type Unspecified
NYT26484Medicare UPIN