Provider Demographics
NPI:1699946905
Name:DR DANIEL K MCLELLAN
Entity type:Organization
Organization Name:DR DANIEL K MCLELLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-683-4874
Mailing Address - Street 1:4610 LOFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2023
Mailing Address - Country:US
Mailing Address - Phone:270-683-4874
Mailing Address - Fax:
Practice Address - Street 1:5000 FREDERICA STREET
Practice Address - Street 2:#35
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-7424
Practice Address - Country:US
Practice Address - Phone:270-683-4874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY964DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty