Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 18002327A | IN |
N | 152WP0200X | Pediatric Optomitrist | 18002327A | IN |
N | 152WS0006X | Sports Vision | 18002327A | IN |
N | 152WX0102X | Occupational Vision | 18002327A | IN |
NPI | 1205900214 |
---|---|
Provider Name | Dr. Daniel Donald Wendorff |
First Address | Greenwood, IN 46142-4503 |
Second Address | Greenwood, IN 46142-4503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T88907 | (02) | IN |