Provider Demographics
NPI:1689794794
Name:DANIEL HEDLUND O. D
Entity Type:Organization
Organization Name:DANIEL HEDLUND O. D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HEDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:814-868-0895
Mailing Address - Street 1:1344 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2462
Mailing Address - Country:US
Mailing Address - Phone:814-868-0895
Mailing Address - Fax:814-868-0896
Practice Address - Street 1:1344 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2462
Practice Address - Country:US
Practice Address - Phone:814-868-0895
Practice Address - Fax:814-868-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 332H00000X
PAOEG000644152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0130230001OtherAFTER CATERACT SURGERY
PA223758OtherEYEMED
PA391867OtherNVA
PAPA06024OtherVISION BENEFITS OF AMERIC
PA208918OtherUPMC
PA96123OtherHEALTH AMERICA
PAP00100699OtherMEDICARE RAILROAD
PA391867OtherNVA
PA0130230001Medicare NSC