Provider Demographics
NPI:1730242207
Name:KROGER, DANIEL JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:KROGER
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 1:7322 KINGSGATE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6566
Mailing Address - Country:US
Mailing Address - Phone:513-777-3936
Mailing Address - Fax:513-777-4746
Practice Address - Street 1:7322 KINGSGATE WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6566
Practice Address - Country:US
Practice Address - Phone:513-777-3936
Practice Address - Fax:513-777-4746
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3868T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT80585Medicare UPIN
OHH085480Medicare PIN
OH0747190001Medicare NSC