Provider Demographics
NPI:1376612135
Name:JOHN M. PRICE OD, INC.
Entity Type:Organization
Organization Name:JOHN M. PRICE OD, INC.
Other - Org Name:OAKWOOD FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARINDA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WINE
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:419-594-3340
Mailing Address - Street 1:113 NORTH FIRST ST.
Mailing Address - Street 2:P.O. BOX 168
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45873
Mailing Address - Country:US
Mailing Address - Phone:419-594-3340
Mailing Address - Fax:419-594-3300
Practice Address - Street 1:113 NORTH FIRST ST.
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45873
Practice Address - Country:US
Practice Address - Phone:419-594-3340
Practice Address - Fax:419-594-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty