Provider Demographics
NPI:1477692341
Name:PIERCE, JOHN R JR (ORTHOTIST PROSTHETIS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:PIERCE
Suffix:JR
Gender:M
Credentials:ORTHOTIST PROSTHETIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2286
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77574-2286
Mailing Address - Country:US
Mailing Address - Phone:979-299-0005
Mailing Address - Fax:979-299-0008
Practice Address - Street 1:107 W WAY ST
Practice Address - Street 2:SUITE 13
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5219
Practice Address - Country:US
Practice Address - Phone:979-299-0005
Practice Address - Fax:979-299-0008
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN010721101Medicaid
TXC08488733Medicare NSC