Provider Demographics
NPI:1962460311
Name:MCDANIEL, DAVID RONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RONALD
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 1:510 W KING ST
Mailing Address - Street 2:PO BOX 1127
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3310
Mailing Address - Country:US
Mailing Address - Phone:704-739-1394
Mailing Address - Fax:704-739-2332
Practice Address - Street 1:510 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3310
Practice Address - Country:US
Practice Address - Phone:704-739-1394
Practice Address - Fax:704-739-2332
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909569Medicaid
NC8909569Medicaid
NC246348Medicare ID - Type Unspecified