Daniel O. Elliott III OD

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

DANIEL O. ELLIOTT III OD

Practice address

220 N Ironwood Dr
South Bend, IN 46615-2518

Phone

(574) 233-3617

Fax

(574) 280-7355

NPI assigned

Mar 6, 2008

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Daniel O Elliott III, ODNPI 1083614267

Title

Owner

Phone

(574) 233-3617

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel O. Elliott III, OD

  • Optometrist
  • South Bend, IN
  • NPI 1083614267
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1013187996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N IRONWOOD DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466152518",
            "telephone_number": "574-233-3617",
            "fax_number": "574-280-7355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N IRONWOOD DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466152518",
            "telephone_number": "574-233-3617",
            "fax_number": "574-280-7355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL O. ELLIOTT III OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-06",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-233-3617",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100221940A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in South Bend, IN
• Providers in South Bend, IN by specialty
• Eyewear Supplier in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.