Provider Demographics
NPI:1518384031
Name:DANIEL E. HERMANSON, OD, LTD.
Entity Type:Organization
Organization Name:DANIEL E. HERMANSON, OD, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HERMANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-834-5834
Mailing Address - Street 1:15417 PATRICK CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3912
Mailing Address - Country:US
Mailing Address - Phone:312-834-5834
Mailing Address - Fax:
Practice Address - Street 1:103 W HOLBROOK RD
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425-1555
Practice Address - Country:US
Practice Address - Phone:708-755-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046010221Medicaid