Healthcare Provider Details

I. General information

NPI: 1215905294
Provider Name (Legal Business Name): DANIEL L MEFFLEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N CLINTON ST SUITE
DEFIANCE OH
43512-4611
US

IV. Provider business mailing address

800 N CLINTON ST SUITE
DEFIANCE OH
43512-4611
US

V. Phone/Fax

Practice location:
  • Phone: 419-782-9082
  • Fax: 419-782-2200
Mailing address:
  • Phone: 419-782-9082
  • Fax: 419-782-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3322
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: