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NPI Code Detail

MEDICARE: DR. THADDEUS DANIEL

MEDICARE: DR. THADDEUS DANIEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2396CO
2152W00000XOptometrist2359WI

General Provider Information

NPI Number : 1366576399
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THADDEUS DANIEL
Provider Business Mailing Address
First Line : 1244 E GREEN BAY ST
Second Line :
City : SHAWANO
State : WI
Zip : 54166-2208
Country : US
Telephone Number : 715-526-2376
Fax Number : 715-526-9651
Provider Business Practice Location Address
First Line : 1244 E GREEN BAY ST
Second Line : OPTICAL DEPT
City : SHAWANO
State : WI
Zip : 54166-2208
Country : US
Telephone Number : 715-526-2376
Fax Number : 715-526-9651
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 03/19/2025

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