Provider Demographics
NPI:1093885741
Name:EMCH OD, JOHN D
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:EMCH OD
Suffix:
Gender:M
Credentials:
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 93
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-0093
Mailing Address - Country:US
Mailing Address - Phone:419-445-0436
Mailing Address - Fax:419-445-2697
Practice Address - Street 1:700 STRYKER ST
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-1037
Practice Address - Country:US
Practice Address - Phone:419-445-0436
Practice Address - Fax:419-445-2697
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3230T421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0314403Medicaid
OHT46818Medicare UPIN
OH0428361Medicare PIN
OH0468210002Medicare NSC