Provider Demographics
NPI:1023006327
Name:VEITH, JOHN P (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:VEITH
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 1:2723 S STATE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6188
Mailing Address - Country:US
Mailing Address - Phone:800-551-7347
Mailing Address - Fax:
Practice Address - Street 1:1116 W GANSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4240
Practice Address - Country:US
Practice Address - Phone:800-551-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901061141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4193184Medicaid
MI4193175Medicaid
MI4193200Medicaid
410046864OtherRAILROAD MEDICARE
MI900C848370OtherBCBSM
MI900C848370OtherBCBSM
OTH001Medicare UPIN
MI4193184Medicaid