Provider Demographics
NPI:1790767150
Name:POKORNY, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:POKORNY
Suffix:
Gender:M
Credentials:MD
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 160
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-0160
Mailing Address - Country:US
Mailing Address - Phone:785-628-8218
Mailing Address - Fax:785-628-8617
Practice Address - Street 1:2214 CANTERBURY DR
Practice Address - Street 2:STE. 312
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2375
Practice Address - Country:US
Practice Address - Phone:785-628-8218
Practice Address - Fax:785-628-8617
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24729207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS611720Medicaid
KS611720Medicaid
NE271775Medicare ID - Type Unspecified
KS045447Medicare ID - Type Unspecified