Individual
DR. DANIEL JAMES KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
25 W HUBBARD AVE, COLUMBUS, OH 43215-1410
(614) 421-2020
(614) 421-9115
Mailing address
25 W HUBBARD AVE, COLUMBUS, OH 43215-1410
(614) 421-2020
(614) 421-9115
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1226
CO
152W00000X
Optometrist
Primary
3759T520
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000134652
ANTHEM BC PROVIDER ID #
OH
05
—
0821114
—
OH
01
—
1325654
WORKERS' COMP. RISK #
OH
01
—
34-1585183
FEDERAL TAX ID #
OH
01
—
34-1585183-00
BWC PROVIDER NUMBER
OH
01
—
4628497
AETNA PROVIDER ID #
OH
Enumeration date
11/16/2006
Last updated
09/05/2013
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