Provider Demographics
NPI:1447240569
Name:COMPTON, JOHN RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:COMPTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2024
Mailing Address - Country:US
Mailing Address - Phone:616-846-0620
Mailing Address - Fax:616-844-6079
Practice Address - Street 1:8950 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-8399
Practice Address - Country:US
Practice Address - Phone:313-295-3937
Practice Address - Fax:313-295-2006
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383628290OtherTAX ID
MI900F210170OtherBCBS OF MICHIGAN
MIP15470001Medicare PIN
MI900F210170OtherBCBS OF MICHIGAN
MIT79424Medicare UPIN
MI5375940006Medicare NSC
MIOP13290Medicare PIN