Provider Demographics
NPI:1497856645
Name:KHONG, DANIEL T (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:T
Last Name:KHONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2645 MANHATTAN BLVD STE E2B
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-3375
Mailing Address - Country:US
Mailing Address - Phone:504-309-8619
Mailing Address - Fax:504-218-4190
Practice Address - Street 1:1620 BELLE CHASSE HWY
Practice Address - Street 2:STE B
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7057
Practice Address - Country:US
Practice Address - Phone:504-309-8619
Practice Address - Fax:504-218-4190
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1185-338T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7346355OtherCIGNA
LA1162990Medicaid
LA5045870001OtherPTAN
5045870001Medicare NSC
LAU60329Medicare UPIN
LA7346355OtherCIGNA