Provider Demographics
NPI:1770670499
Name:KOHLER, JOHN ELWOOD (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELWOOD
Last Name:KOHLER
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 1:1021 ISABELLA AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2819
Mailing Address - Country:US
Mailing Address - Phone:619-437-4461
Mailing Address - Fax:619-435-1218
Practice Address - Street 1:1021 ISABELLA AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2819
Practice Address - Country:US
Practice Address - Phone:619-437-4461
Practice Address - Fax:619-435-1218
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5419TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6194374461OtherVSP
CA060014461OtherMEDICAL EYE SERVICES
CACA5419OtherEYE MED
CA6194374461OtherTRI WEST
CAAU379Medicare PIN
CA6194374461OtherVSP
CAOP5419Medicare ID - Type Unspecified
CA060014461OtherMEDICAL EYE SERVICES