Provider Demographics
NPI:1770655961
Name:JON D. MORRISON, O.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JON D. MORRISON, O.D. A PROFESSIONAL CORPORATION
Other - Org Name:LAKE FOREST OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-581-6880
Mailing Address - Street 1:22741 LAMBERT ST STE 1601
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1617
Mailing Address - Country:US
Mailing Address - Phone:949-581-6880
Mailing Address - Fax:
Practice Address - Street 1:22741 LAMBERT ST STE 1601
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1617
Practice Address - Country:US
Practice Address - Phone:949-581-6880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5914T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWY135Medicare PIN