Provider Demographics
NPI:1497732010
Name:DANAHEY, KEVIN A (OD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:DANAHEY
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 1:230 E DAY RD
Mailing Address - Street 2:100
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3408
Mailing Address - Country:US
Mailing Address - Phone:574-271-3939
Mailing Address - Fax:574-271-3941
Practice Address - Street 1:230 E DAY RD
Practice Address - Street 2:100
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3408
Practice Address - Country:US
Practice Address - Phone:574-271-3939
Practice Address - Fax:574-271-3941
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002620A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100363220AMedicaid
IN18002620AOtherOPTOMETRIST LICENSE
INP00014931OtherRR MEDICARE
IN4823160002Medicare NSC
IN4823160004Medicare PIN
IN18002620AOtherOPTOMETRIST LICENSE
IN4823160003Medicare NSC
INU43575Medicare UPIN
IN4823160001Medicare NSC