Healthcare Provider Details

I. General information

NPI: 1689794794
Provider Name (Legal Business Name): DANIEL HEDLUND O. D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 W 38TH ST
ERIE PA
16508-2462
US

IV. Provider business mailing address

1344 W 38TH ST
ERIE PA
16508-2462
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-0895
  • Fax: 814-868-0896
Mailing address:
  • Phone: 814-868-0895
  • Fax: 814-868-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000644
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DANIEL LEE HEDLUND
Title or Position: OWNER
Credential: O. D.
Phone: 814-868-0895