Provider Demographics
NPI:1194743096
Name:MARCHANT, DANIEL (OD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MARCHANT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3413
Mailing Address - Country:US
Mailing Address - Phone:316-636-2010
Mailing Address - Fax:316-691-4408
Practice Address - Street 1:707 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:KS
Practice Address - Zip Code:67003-2752
Practice Address - Country:US
Practice Address - Phone:620-842-5596
Practice Address - Fax:620-842-3521
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5634152W00000X
KS1842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200616570AMedicaid
OH2710972Medicaid
OH4198091Medicare PIN
KS200616570AMedicaid
OHP00445304Medicare PIN
OHP00402158Medicare PIN
OH4198094Medicare PIN
OH4198093Medicare PIN
KS110162010Medicare PIN
OH2710972Medicaid
OH4198096Medicare PIN