Provider Demographics
NPI:1225029556
Name:SODERLING, JOHN MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:SODERLING
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 1:136 E MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1576
Mailing Address - Country:US
Mailing Address - Phone:270-338-9636
Mailing Address - Fax:270-338-9639
Practice Address - Street 1:136 E MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1576
Practice Address - Country:US
Practice Address - Phone:270-338-9636
Practice Address - Fax:270-338-9639
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1281DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21435OtherAVESIS
KY77012813Medicaid
25125OtherGE
P00107376OtherRAILROAD MEDICARE
297436OtherOPTICHOICE
DB4678OtherRAILROAD MEDICARE GROUP
KY1281OtherEYEMED
180034OtherNVA
21435OtherAVESIS
P00107376OtherRAILROAD MEDICARE
U53300Medicare UPIN