Provider Demographics
NPI:1598847691
Name:MOHR, JOHN H (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:MOHR
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 1:131 MOHR DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-9412
Mailing Address - Country:US
Mailing Address - Phone:601-939-3700
Mailing Address - Fax:601-932-4777
Practice Address - Street 1:2630 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-3403
Practice Address - Country:US
Practice Address - Phone:601-939-3700
Practice Address - Fax:601-932-4777
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880180Medicaid
MST21100Medicare UPIN