Healthcare Provider Details

I. General information

NPI: 1740279793
Provider Name (Legal Business Name): DANIEL DAYTON BISHOP OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 CAPITOL ST NE
SALEM OR
97301-2504
US

IV. Provider business mailing address

4125 RIVERCREST DR N
KEIZER OR
97303-5910
US

V. Phone/Fax

Practice location:
  • Phone: 503-364-0512
  • Fax:
Mailing address:
  • Phone: 503-393-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1472ATI
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: