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General NPI Number Information
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NPI Number | 1699946905
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Entity Type | Organization
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Legal Business Name | DR DANIEL K MCLELLAN
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 5000 FREDERICA STREET #35
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City | OWENSBORO
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State | KY
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Zip | 42301-7424
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Country | US
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Telephone | 270-683-4874
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Fax |
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Provider Business Mailing Address
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Address Line | 4610 LOFTWOOD DR
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City | OWENSBORO
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State | KY
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Zip | 42303-2023
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Country | US
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Telephone | 270-683-4874
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL K MCLELLAN
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Credential |
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Telephone | 270-683-4874
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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 | 964DT
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License Number State | KY
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