Provider Demographics
NPI:1467411181
Name:COYLE, DANIEL D (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:D
Last Name:COYLE
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 1:174 BEAUREGARD RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-2089
Mailing Address - Country:US
Mailing Address - Phone:843-821-0261
Mailing Address - Fax:843-821-0283
Practice Address - Street 1:174 BEAUREGARD RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-2089
Practice Address - Country:US
Practice Address - Phone:843-821-0261
Practice Address - Fax:843-821-0283
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD08258Medicaid
SCD08258Medicaid
SCT238730281Medicare PIN