Provider Demographics
NPI:1023016284
Name:MOHN, MICHAEL R (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:MOHN
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 1:453 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1371
Mailing Address - Country:US
Mailing Address - Phone:610-775-3321
Mailing Address - Fax:610-775-8542
Practice Address - Street 1:453 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1371
Practice Address - Country:US
Practice Address - Phone:610-775-3321
Practice Address - Fax:610-775-8542
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000048152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410006144OtherMEDICARE RAILROAD
PA175051J44Medicare PIN
PA0326710001Medicare NSC
PAT72836Medicare UPIN