Healthcare Provider Details

I. General information

NPI: 1316004807
Provider Name (Legal Business Name): KENNETH DANIELS, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S FRANKLIN ST
LAMBERTVILLE NJ
08530-1302
US

IV. Provider business mailing address

PO BOX 3538
PRINCETON NJ
08543-3538
US

V. Phone/Fax

Practice location:
  • Phone: 609-397-7020
  • Fax: 609-397-7023
Mailing address:
  • Phone: 609-514-0663
  • Fax: 609-514-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00491300
License Number StateNJ

VIII. Authorized Official

Name: DR. KENNETH MARTIN DANIELS
Title or Position: OWNER
Credential: O.D.
Phone: 609-514-0663