Provider Demographics
NPI:1205900214
Name:WENDORFF, DANIEL DONALD (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DONALD
Last Name:WENDORFF
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 1:1251 US HIGHWAY 31 N
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-4503
Mailing Address - Country:US
Mailing Address - Phone:317-887-2732
Mailing Address - Fax:317-865-8121
Practice Address - Street 1:1251 US HIGHWAY 31 N
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-4503
Practice Address - Country:US
Practice Address - Phone:317-887-2732
Practice Address - Fax:317-865-8121
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002327A152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT88907Medicare UPIN
IN178880DMedicare ID - Type Unspecified