Provider Demographics
NPI:1477719938
Name:MCDANIEL, JAMES BURNARD (OD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BURNARD
Last Name:MCDANIEL
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 1:2403 SE OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-3525
Mailing Address - Country:US
Mailing Address - Phone:907-378-1053
Mailing Address - Fax:
Practice Address - Street 1:2008 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3340
Practice Address - Country:US
Practice Address - Phone:785-354-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1815152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS650522001Medicare PIN