Provider Demographics
NPI:1689746018
Name:VEACH, JOHN E (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:VEACH
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 1:384 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-1751
Mailing Address - Country:US
Mailing Address - Phone:231-723-9911
Mailing Address - Fax:
Practice Address - Street 1:384 1ST ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1751
Practice Address - Country:US
Practice Address - Phone:231-723-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI410028046OtherRR MEDICARE
MI0E17604001OtherBCBSMI
MI1785083Medicaid
MIT33231Medicare UPIN
MI0E17604001OtherBCBSMI