Healthcare Provider Details

I. General information

NPI: 1487823571
Provider Name (Legal Business Name): DANIEL C. DROUGHT O.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 07/26/2010
Certification Date:
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 Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL C DROUGHT
Title or Position: OWNER
Credential: O.D.
Phone: 440-466-4661