Provider Demographics
NPI:1841357977
Name:DANIELS, KENNETH MARTIN (OD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MARTIN
Last Name:DANIELS
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 1:4 COLEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-7049
Mailing Address - Country:US
Mailing Address - Phone:609-514-0663
Mailing Address - Fax:609-514-0663
Practice Address - Street 1:4 COLEBROOK CT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7049
Practice Address - Country:US
Practice Address - Phone:609-514-0663
Practice Address - Fax:609-514-0663
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00491300152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT29356Medicare UPIN