Individual
DANIEL P. ETHAKOTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3732 S KINGSHIGHWAY BLVD, SAINT LOUIS, MO 63109-1800
(314) 446-1134
(314) 446-1136
Mailing address
211 E BROADWAY, ALTON, IL 62002-6220
(618) 462-9818
(800) 432-6004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2015020209
MO
Other
Enumeration date
06/24/2015
Last updated
06/24/2015
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