Provider Demographics
NPI:1982833711
Name:HERMANSON, DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:HERMANSON
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 1:103 W HOLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1555
Mailing Address - Country:US
Mailing Address - Phone:708-755-1330
Mailing Address - Fax:708-755-1476
Practice Address - Street 1:3320 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4531
Practice Address - Country:US
Practice Address - Phone:708-735-8461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist