MEDICARE: JOCELYN RENEE DANIEL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6138 T3053	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336409879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOCELYN RENEE DANIEL OD

Provider Business Mailing Address
First Line	:	2209 WALNUT WAY
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035-7795
Country	:	US
Telephone Number	:	740-579-1038
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 MCNAUGHTEN RD STE 200
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2129
Country	:	US
Telephone Number	:	614-863-3937
Fax Number	:	614-863-5010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	09/19/2019

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