Provider Demographics
NPI:1538681382
Name:TEW, DANIEL B JR (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:TEW
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2216 MARGATE CT
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8689
Mailing Address - Country:US
Mailing Address - Phone:502-599-9998
Mailing Address - Fax:
Practice Address - Street 1:3571 SPRINGHURST BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-4144
Practice Address - Country:US
Practice Address - Phone:502-339-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004060A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist