Provider Demographics
NPI:1275949000
Name:ST JOHN, DANIELLE CHRISTINE (OD)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:CHRISTINE
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:CHRISTINE
Other - Last Name:KALBERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:79 MIDDLEVILLE RD
Mailing Address - Street 2:OPTOMETRY SERVICE 123
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768
Mailing Address - Country:US
Mailing Address - Phone:631-261-4400
Mailing Address - Fax:
Practice Address - Street 1:79 MIDDLEVILLE RD
Practice Address - Street 2:OPTOMETRY SERVICE 123
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008175-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist