Provider Demographics
NPI:1740260009
Name:MCDANIEL, TIMOTHY S (OD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:MCDANIEL
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 1:55 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1931
Mailing Address - Country:US
Mailing Address - Phone:607-324-7710
Mailing Address - Fax:
Practice Address - Street 1:55 CENTER ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1931
Practice Address - Country:US
Practice Address - Phone:607-324-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT004436-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY38645DMedicare ID - Type UnspecifiedUPSTATE MEDICARE