Healthcare Provider Details

I. General information

NPI: 1093885741
Provider Name (Legal Business Name): JOHN D EMCH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 STRYKER ST
ARCHBOLD OH
43502-1037
US

IV. Provider business mailing address

PO BOX 93
ARCHBOLD OH
43502-0093
US

V. Phone/Fax

Practice location:
  • Phone: 419-445-0436
  • Fax: 419-445-2697
Mailing address:
  • Phone: 419-445-0436
  • Fax: 419-445-2697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3230T421
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: