Provider Demographics
NPI:1639161615
Name:MUIR, JOHN WILLIAM JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:MUIR
Suffix:JR
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 1:810 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2432
Mailing Address - Country:US
Mailing Address - Phone:517-545-2020
Mailing Address - Fax:517-545-2002
Practice Address - Street 1:810 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2432
Practice Address - Country:US
Practice Address - Phone:517-545-2020
Practice Address - Fax:517-545-2002
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003945152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI90OD700040OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI4490133Medicaid
MIN26930168Medicare PIN
MI90OD700040OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MIP47900001Medicare PIN