Provider Demographics
NPI:1245378967
Name:FANNING, JOHN F (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:FANNING
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 1:6105 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-9000
Mailing Address - Country:US
Mailing Address - Phone:614-793-8440
Mailing Address - Fax:614-793-8383
Practice Address - Street 1:6105 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-9000
Practice Address - Country:US
Practice Address - Phone:614-793-8440
Practice Address - Fax:614-793-8383
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 3707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH23837OtherSPECTERA
OH000000119325OtherANTHEM BLUE CROSS
OH2200157OtherUNITED HEALTHCARE
OH0809637OtherAETNA
OHOH-3707OtherEYEMED
OH0809637OtherAETNA
OHT47873Medicare UPIN
OH0808420001Medicare NSC