Provider Demographics
NPI:1194794958
Name:O'CONNOR, DANIEL J
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7243
Mailing Address - Country:US
Mailing Address - Phone:508-833-6000
Mailing Address - Fax:508-534-6060
Practice Address - Street 1:146 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7243
Practice Address - Country:US
Practice Address - Phone:508-833-6000
Practice Address - Fax:508-534-6060
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80113207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110056437AMedicaid
MA3145051Medicaid
MADX5780Medicare PIN
MA110056437AMedicaid
MA3145051Medicaid
MAS400145702Medicare PIN