MEDICARE: DR. DANIEL JAMES KOCH O.D.

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	3759T520	OH
2	152W00000X	Optometrist	1226	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4628497	OTHER	OH	AETNA PROVIDER ID #
2	1325654	OTHER	OH	WORKERS' COMP. RISK #
3	34-1585183-00	OTHER	OH	BWC PROVIDER NUMBER
4	000000134652	OTHER	OH	ANTHEM BC PROVIDER ID #
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	34-1585183	OTHER	OH	FEDERAL TAX ID #

General Provider Information

NPI Number	:	1669545042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JAMES KOCH O.D.

Provider Business Mailing Address
First Line	:	25 W HUBBARD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1410
Country	:	US
Telephone Number	:	614-421-2020
Fax Number	:	614-421-9115

Provider Business Practice Location Address
First Line	:	25 W HUBBARD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1410
Country	:	US
Telephone Number	:	614-421-2020
Fax Number	:	614-421-9115

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	09/05/2013

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