Provider Demographics
NPI:1417294091
Name:ANTHONY, JOHN RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAYMOND
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6667 LA JOLLA SCENIC DR S
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5735
Mailing Address - Country:US
Mailing Address - Phone:858-454-0464
Mailing Address - Fax:858-454-3800
Practice Address - Street 1:6667 LA JOLLA SCENIC DR S
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5735
Practice Address - Country:US
Practice Address - Phone:858-454-0464
Practice Address - Fax:858-454-3800
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4961T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist