Provider Demographics
NPI:1922094879
Name:HERKERT, DANIEL L (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:HERKERT
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 1:6904 S EAST ST STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2694
Mailing Address - Country:US
Mailing Address - Phone:317-784-5665
Mailing Address - Fax:317-784-7011
Practice Address - Street 1:6904 S EAST ST STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2694
Practice Address - Country:US
Practice Address - Phone:317-784-5665
Practice Address - Fax:317-784-7011
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4626909OtherAETNA
ININ2512OtherEYEMED
IN93101OtherANTHEM BCBS
1265680001OtherDMERC ADMINISTAR FEDERAL
INU20174Medicare UPIN
IN410039322Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IN93101OtherANTHEM BCBS