Provider Demographics
NPI:1346216926
Name:ARTEAGA, JOHN W (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:ARTEAGA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4041 N FRESNO ST
Mailing Address - Street 2:STE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4037
Mailing Address - Country:US
Mailing Address - Phone:559-227-7512
Mailing Address - Fax:559-227-7574
Practice Address - Street 1:4041 N FRESNO ST
Practice Address - Street 2:STE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4037
Practice Address - Country:US
Practice Address - Phone:559-227-7512
Practice Address - Fax:559-227-7574
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6159TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0061590Medicaid
CASD0061590Medicare PIN
CA2462310001Medicare NSC
T10250Medicare UPIN