Provider Demographics
NPI:1295814564
Name:NEWBERRY, DANIEL W (OD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:W
Last Name:NEWBERRY
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 1:60 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001
Mailing Address - Country:US
Mailing Address - Phone:270-554-2000
Mailing Address - Fax:270-554-2989
Practice Address - Street 1:60 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001
Practice Address - Country:US
Practice Address - Phone:270-554-2000
Practice Address - Fax:270-554-2989
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1056DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T54717Medicare UPIN
9229601Medicare ID - Type Unspecified
KY0611510001Medicare NSC