MEDICARE: DANIEL C. DROUGHT O.D. INC

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	332H00000X	Eyewear Supplier
2	152W00000X	Optometrist	4017/T415	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000138384	OTHER	OH	BLUE CROSS BLUE SHIELD
2	2377231	OTHER	OH	AETNA

General Provider Information

NPI Number	:	1487823571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL C. DROUGHT O.D. INC

Provider Business Mailing Address
First Line	:	PO BOX 389
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-0389
Country	:	US
Telephone Number	:	440-466-4661
Fax Number	:	440-466-3363

Provider Business Practice Location Address
First Line	:	895 S BROADWAY
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9146
Country	:	US
Telephone Number	:	440-466-4661
Fax Number	:	440-466-3363

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL C DROUGHT
Credential	:	O.D.
Telephone Number	:	440-466-4661

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	07/26/2010

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