Provider Demographics
NPI:1043390867
Name:MERSHON, JAMES WILLIAM (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:MERSHON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:MERSHON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:402 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724
Mailing Address - Country:US
Mailing Address - Phone:740-732-4620
Mailing Address - Fax:740-732-7179
Practice Address - Street 1:402 CUMBERLAND ST
Practice Address - Street 2:CALDWELL VISION CENTRE
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-1234
Practice Address - Country:US
Practice Address - Phone:740-732-4620
Practice Address - Fax:740-732-7179
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3554T948152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0464162Medicaid
OH0529025OtherMEDICARE PTAN
T47804Medicare UPIN
OH0529025Medicare PIN