Healthcare Provider Details

I. General information

NPI: 1457526600
Provider Name (Legal Business Name): JOHN DOUGLAS EMCH OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 STRYKER ST
ARCHBOLD OH
43502
US

IV. Provider business mailing address

PO BOX 93
ARCHBOLD OH
43502
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: DR. JOHN DOUGLAS EMCH
Title or Position: OD
Credential:
Phone: 419-445-0436