Provider Demographics
NPI:1871677427
Name:JOHN M. PRICE OD, INC.
Entity Type:Organization
Organization Name:JOHN M. PRICE OD, INC.
Other - Org Name:ST. MARYS FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-394-2397
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:
Practice Address - Street 1:140 W SPRING ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2312
Practice Address - Country:US
Practice Address - Phone:419-394-2397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2128978Medicaid
OH000000747797OtherANTHEM BC/BS
OH04911OtherPARAMOUNT
OH0892463Medicare PIN
OH04911OtherPARAMOUNT
OH000000747797OtherANTHEM BC/BS