Provider Demographics
NPI:1487823571
Name:DANIEL C. DROUGHT O.D. INC
Entity Type:Organization
Organization Name:DANIEL C. DROUGHT O.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:DROUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-466-4661
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-0389
Mailing Address - Country:US
Mailing Address - Phone:440-466-4661
Mailing Address - Fax:440-466-3363
Practice Address - Street 1:895 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-9146
Practice Address - Country:US
Practice Address - Phone:440-466-4661
Practice Address - Fax:440-466-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4017/T415152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000138384OtherBLUE CROSS BLUE SHIELD
OH2377231OtherAETNA
OH=========001OtherMEDICAL MUTUAL
OH000000138384OtherBLUE CROSS BLUE SHIELD
OH0284480001Medicare NSC
OHDR0652171Medicare PIN