Provider Demographics
NPI:1669442844
Name:DOVIE, JOHN MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:DOVIE
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 29
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24063-0029
Mailing Address - Country:US
Mailing Address - Phone:540-953-2020
Mailing Address - Fax:
Practice Address - Street 1:1440 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-5568
Practice Address - Country:US
Practice Address - Phone:540-953-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV00618Medicare UPIN
VA008159W22Medicare ID - Type Unspecified
VA010179823Medicaid