Provider Demographics
NPI:1013021518
Name:MORRISON, JOHN KENNETH (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENNETH
Last Name:MORRISON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-0910
Mailing Address - Country:US
Mailing Address - Phone:262-728-2667
Mailing Address - Fax:262-728-3539
Practice Address - Street 1:1221 PHOENIX ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-2340
Practice Address - Country:US
Practice Address - Phone:262-728-2667
Practice Address - Fax:262-728-3539
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI516110OtherDEAN HEALTH HMO
WI87442Medicare PIN
WI516110OtherDEAN HEALTH HMO
WI0339080001Medicare NSC