MEDICARE: DR. DAVID RONALD MCDANIEL 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	0991	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962460311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID RONALD MCDANIEL O.D.

Provider Business Mailing Address
First Line	:	510 W KING ST
Second Line	:	PO BOX 1127
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3310
Country	:	US
Telephone Number	:	704-739-1394
Fax Number	:	704-739-2332

Provider Business Practice Location Address
First Line	:	510 W KING ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3310
Country	:	US
Telephone Number	:	704-739-1394
Fax Number	:	704-739-2332

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/27/2010

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