Healthcare Provider Details

I. General information

NPI: 1366571846
Provider Name (Legal Business Name): JOHN T ARCHER & ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 FT AMANDA RD SUITE 100
LIMA OH
45805-3887
US

IV. Provider business mailing address

2765 FT AMANDA RD SUITE 100
LIMA OH
45805-3887
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-3937
  • Fax: 419-228-3939
Mailing address:
  • Phone: 419-228-3937
  • Fax: 419-228-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3762T631
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2552750
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: MRS. CHERYL ARCHER
Title or Position: OWNER
Credential: OD
Phone: 419-228-3937