Provider Demographics
NPI:1770605073
Name:TEEL, DANIELLE FAYE WARREN (OD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:FAYE WARREN
Last Name:TEEL
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:FAYE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:205 CONTERA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-0188
Mailing Address - Country:US
Mailing Address - Phone:260-399-5912
Mailing Address - Fax:260-399-5919
Practice Address - Street 1:9920 ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5770
Practice Address - Country:US
Practice Address - Phone:260-399-5912
Practice Address - Fax:260-399-5919
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003315A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000825523OtherANTHEM
IN300066701Medicaid
IN546000OMedicare PIN
IN200488850Medicaid
IN825700XXMedicare PIN
IN000000342010OtherANTHEM