Provider Demographics
NPI:1497752109
Name:DEATON, JOHN K (OD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:K
Last Name:DEATON
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:PO BOX 130639
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0639
Mailing Address - Country:US
Mailing Address - Phone:903-595-4167
Mailing Address - Fax:903-596-7541
Practice Address - Street 1:1424 EAST FRONT
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8501
Practice Address - Country:US
Practice Address - Phone:903-595-4144
Practice Address - Fax:903-596-7541
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05562TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX70893OtherMEDICARE
TX047945301Medicaid
TX80154QOtherBLUE CROSS BLUE SHIELD
TXP02098771OtherMEDICARE RAIL ROAD
TX1964984OtherUNITED HEALTHCARE
TX21816989OtherFIRST HEALTH
TX7009226OtherAETNA
TX9942374OtherCIGNA
TX047945302Medicaid