Provider Demographics
NPI:1700897543
Name:SHERWOOD, DANIEL W (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1115 N HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2523
Mailing Address - Country:US
Mailing Address - Phone:309-343-1107
Mailing Address - Fax:309-343-1306
Practice Address - Street 1:1115 N HENDERSON ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2523
Practice Address - Country:US
Practice Address - Phone:309-343-1107
Practice Address - Fax:309-343-1306
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006645152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1244410001Medicare NSC