Provider Demographics
NPI:1609815844
Name:DANIEL, TERRY E (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:E
Last Name:DANIEL
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 1:295 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1833
Mailing Address - Country:US
Mailing Address - Phone:440-234-3800
Mailing Address - Fax:440-234-2318
Practice Address - Street 1:295 HIGH ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1833
Practice Address - Country:US
Practice Address - Phone:440-234-3800
Practice Address - Fax:440-234-2318
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2940/T399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11313346OtherCAQH
OH02855-00002OtherDMERC
OHT46787Medicare UPIN
OH02855-00002OtherDMERC