Provider Demographics
NPI:1285639252
Name:OFFERLE, JOHN J (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:OFFERLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:17477 GENERATIONS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1584
Mailing Address - Country:US
Mailing Address - Phone:574-287-0890
Mailing Address - Fax:574-287-0899
Practice Address - Street 1:17477 GENERATIONS DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1584
Practice Address - Country:US
Practice Address - Phone:574-287-0890
Practice Address - Fax:574-287-0899
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200247660Medicaid
IN100091030BMedicaid
IN200247660Medicaid
INT35013Medicare UPIN