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General NPI Number Information
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NPI Number | 1538681382
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Entity Type | Individual
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Provider Name | DANIEL B TEW JR. OD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/13/2017
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Provider Practice Location Address
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Address Line | 3571 SPRINGHURST BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40241-4144
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Country | US
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Telephone | 502-339-7323
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Fax |
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Provider Business Mailing Address
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Address Line | 2216 MARGATE CT
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City | LA GRANGE
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State | KY
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Zip | 40031-8689
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Country | US
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Telephone | 502-599-9998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18004060A
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License Number State | IN
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