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General NPI Number Information
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NPI Number | 1497752109
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Entity Type | Individual
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Provider Name | JOHN K DEATON O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 1424 EAST FRONT
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City | TYLER
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State | TX
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Zip | 75702-8501
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Country | US
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Telephone | 903-595-4144
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Fax | 903-596-7541
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Provider Business Mailing Address
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Address Line | PO BOX 130639
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City | TYLER
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State | TX
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Zip | 75713-0639
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Country | US
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Telephone | 903-595-4167
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Fax | 903-596-7541
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 05562TG
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License Number State | TX
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