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General NPI Number Information
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NPI Number | 1821287244
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Entity Type | Organization
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Legal Business Name | JOHN M PRICE OD INC
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 315 EAST COLUMBUS AVE
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2001
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Country | US
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Telephone | 937-592-9966
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Fax | 937-592-4060
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Provider Business Mailing Address
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Address Line | 315 EAST COLUMBUS AVE
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2001
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Country | US
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Telephone | 937-592-9966
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Fax | 937-592-4060
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Authorized Official
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Title or Position | OWNER
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Name | JOHN M. PRICE
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Credential | O.D.
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Telephone | 937-592-9966
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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 | 5062 T1939
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License Number State | OH
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