Individual provider · NPI-1

Dr. Thaddeus Daniel

Optometrist · Shawano, WI

NPI number1366576399
StatusActive
Last updated in NPPESMar 19, 2025

Details

NPI
1366576399
Entity type
Individual (NPI-1)
Name
Dr. Thaddeus Daniel
Sex
Male
Sole proprietor
Yes
Enumeration date
Mar 14, 2007
Certification date
Mar 19, 2025
Last updated
Mar 19, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X Optometrist2359WIYes
152W00000X Optometrist2396CO

Other names

  • Thad Daniel (Other Name)

Practice location

1244 E Green Bay St
Optical Dept
Shawano, WI 54166-2208

Phone 715-526-2376 · Fax 715-526-9651

Mailing address

1244 E Green Bay St
Shawano, WI 54166-2208

Phone 715-526-2376 · Fax 715-526-9651

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