=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487953774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN W MORTON, O.D.,P.S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2011
-----------------------------------------------------
Last Update Date | 03/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 13TH ST
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41101-2607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-329-1404
-----------------------------------------------------
Fax | 606-325-7446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 13TH ST
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41101-2607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-329-1404
-----------------------------------------------------
Fax | 606-325-7446
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOHN W MORTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-329-1404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 803DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------