Provider Demographics
NPI:1265585012
Name:HALLFORTH, DANIEL LOUIS (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LOUIS
Last Name:HALLFORTH
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 1:7840 CONNECTOR DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1435
Mailing Address - Country:US
Mailing Address - Phone:859-283-5055
Mailing Address - Fax:859-371-6677
Practice Address - Street 1:7840 CONNECTOR DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1435
Practice Address - Country:US
Practice Address - Phone:859-283-5055
Practice Address - Fax:859-371-6677
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY921 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist