Healthcare Provider Details

I. General information

NPI: 1255474482
Provider Name (Legal Business Name): DANIEL C DROUGHT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 S BROADWAY
GENEVA OH
44041-9146
US

IV. Provider business mailing address

PO BOX 389
GENEVA OH
44041-0389
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-4661
  • Fax: 440-466-3363
Mailing address:
  • Phone: 440-466-4661
  • Fax: 440-466-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4017/T415
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4017/T415
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number4017/T415
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number4017 T415
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: