Provider Demographics
NPI:1508908211
Name:DEVITO, JOHN JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:DEVITO
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 1:3703 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-2315
Mailing Address - Country:US
Mailing Address - Phone:330-493-9803
Mailing Address - Fax:330-493-9804
Practice Address - Street 1:3703 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-2315
Practice Address - Country:US
Practice Address - Phone:330-493-9803
Practice Address - Fax:330-493-9804
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4094T860152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0765319Medicaid
OH0157111Medicare PIN
OHT46055Medicare UPIN