=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134165392
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN W DIERING OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2006
-----------------------------------------------------
Last Update Date | 06/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 ROUTE 168 SUITE E5
-----------------------------------------------------
City | TURNERSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08012-3233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-227-0720
-----------------------------------------------------
Fax | 856-227-8550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 ROUTE 168
-----------------------------------------------------
City | TURNERSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08012-3233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-227-0720
-----------------------------------------------------
Fax | 856-227-8550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WV0400X
-----------------------------------------------------
Taxonomy Name | Vision Therapy Optometrist
-----------------------------------------------------
License Number | 04944
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------