MEDICARE: DR. DANIEL TIMOTHY CREIGHTON OD

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
1	152W00000X	Optometrist	T0046551	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	904916	OTHER	NY	BLOCK INSURANCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386650422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL TIMOTHY CREIGHTON OD

Provider Business Mailing Address
First Line	:	40 BEMENT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-1501
Country	:	US
Telephone Number	:	718-448-8313
Fax Number	:

Provider Business Practice Location Address
First Line	:	1884 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3514
Country	:	US
Telephone Number	:	718-273-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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