Provider Demographics
NPI:1497739643
Name:HEMMING, JOHN P (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:HEMMING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 COOLIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1378
Mailing Address - Country:US
Mailing Address - Phone:517-337-1668
Mailing Address - Fax:517-337-1779
Practice Address - Street 1:1170 JORDAN LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849-1212
Practice Address - Country:US
Practice Address - Phone:616-374-3284
Practice Address - Fax:616-374-2020
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002697152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4487209Medicaid
MIP00174370OtherRAILROAD MEDICARE
MI200000002103OtherPHPMM
MI4487218Medicaid
MIJH002697OtherSTATE LICENSE NUMBER
MIJH002697OtherSTATE LICENSE NUMBER
MIT92267Medicare UPIN