=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245333715
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN T ARCHER & ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 05/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1222 RIDGEWOOD DR
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43402-2664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-352-2502
-----------------------------------------------------
Fax | 419-352-1281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 518 ERIE COURT
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-352-2502
-----------------------------------------------------
Fax | 419-352-1281
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN T ARCHER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 419-352-2502
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 5292T2201
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------