MEDICARE: MICHAEL R MOHN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000048	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410006144	OTHER	PA	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1023016284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R MOHN O.D.

Provider Business Mailing Address
First Line	:	453 E LANCASTER AVE
Second Line	:
City	:	SHILLINGTON
State	:	PA
Zip	:	19607-1371
Country	:	US
Telephone Number	:	610-775-3321
Fax Number	:	610-775-8542

Provider Business Practice Location Address
First Line	:	453 E LANCASTER AVE
Second Line	:
City	:	SHILLINGTON
State	:	PA
Zip	:	19607-1371
Country	:	US
Telephone Number	:	610-775-3321
Fax Number	:	610-775-8542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	03/13/2014

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