Provider Demographics
NPI:1952389454
Name:NEITZ, DANNY W (OD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:W
Last Name:NEITZ
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 1:803 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-2105
Mailing Address - Country:US
Mailing Address - Phone:610-948-7120
Mailing Address - Fax:610-948-4433
Practice Address - Street 1:803 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-2105
Practice Address - Country:US
Practice Address - Phone:610-948-7120
Practice Address - Fax:610-948-4433
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0397386000OtherKEYSTONE HEALTH CARE EAST
PA103247990Medicaid
PA192127YJZHMedicare PIN
PA575706Medicare ID - Type Unspecified
PA103247990Medicaid
PA0350940001Medicare NSC