Provider Demographics
NPI:1841393709
Name:PRICE, JOHN M (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:PRICE
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 1:140 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2312
Mailing Address - Country:US
Mailing Address - Phone:419-394-2397
Mailing Address - Fax:419-932-9788
Practice Address - Street 1:1201 DEFIANCE ST
Practice Address - Street 2:SUITE A
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-1059
Practice Address - Country:US
Practice Address - Phone:419-738-2715
Practice Address - Fax:419-738-2815
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5062 T1939152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2128978Medicaid
OH0892463Medicare PIN
OH2128978Medicaid
OH0892465Medicare PIN
OHU77378Medicare UPIN
OH5189820001Medicare PIN
OH0892464Medicare PIN