Provider Demographics
NPI:1528197282
Name:GRIFFITT, DANIEL MATTHEW (OD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MATTHEW
Last Name:GRIFFITT
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 1:1104 DOEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2093
Mailing Address - Country:US
Mailing Address - Phone:812-949-0590
Mailing Address - Fax:
Practice Address - Street 1:5000 SHELBYVILLE RD
Practice Address - Street 2:J.C. PENNEY OPTICAL
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3342
Practice Address - Country:US
Practice Address - Phone:502-895-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1299DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist