Provider Demographics
NPI:1740279793
Name:BISHOP, DANIEL DAYTON (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DAYTON
Last Name:BISHOP
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 1:4125 RIVERCREST DR N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5910
Mailing Address - Country:US
Mailing Address - Phone:503-393-6148
Mailing Address - Fax:
Practice Address - Street 1:660 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2504
Practice Address - Country:US
Practice Address - Phone:503-364-0512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1472ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67431OtherUPIN
OR11376-1Medicaid
ORMB0978734OtherDEA NUMBER
ORR0000PGDGZMedicare PIN