Provider Demographics
NPI:1760659957
Name:DANIEL J NIEDERKOHR OD INC
Entity Type:Organization
Organization Name:DANIEL J NIEDERKOHR OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIEDERKOHR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-642-1916
Mailing Address - Street 1:105 MOREY DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1647
Mailing Address - Country:US
Mailing Address - Phone:937-642-1916
Mailing Address - Fax:937-642-3620
Practice Address - Street 1:105 MOREY DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1647
Practice Address - Country:US
Practice Address - Phone:937-642-1916
Practice Address - Fax:937-642-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0306387Medicaid
OH0306387Medicaid
OHNI0446181Medicare PIN