Provider Demographics
NPI:1548540107
Name:DETWILER, DANIEL ANDREW (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ANDREW
Last Name:DETWILER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:933 SOUTH HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206
Mailing Address - Country:US
Mailing Address - Phone:614-444-6366
Mailing Address - Fax:614-269-4155
Practice Address - Street 1:933 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2523
Practice Address - Country:US
Practice Address - Phone:614-444-6366
Practice Address - Fax:614-269-4155
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6029/T2944152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist