Provider Demographics
NPI:1407101439
Name:DANIEL, JOSHUA LEE (OD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:LEE
Last Name:DANIEL
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 1:211 PROVIDENCE HILL DR
Mailing Address - Street 2:APT 128
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2293
Mailing Address - Country:US
Mailing Address - Phone:606-369-4329
Mailing Address - Fax:
Practice Address - Street 1:500 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7362
Practice Address - Country:US
Practice Address - Phone:606-324-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1885DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist