Provider Demographics
NPI:1891809356
Name:TAYLOR, JOHN W (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:59 BARRY ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1809
Mailing Address - Country:US
Mailing Address - Phone:517-437-4300
Mailing Address - Fax:517-437-3898
Practice Address - Street 1:59 BARRY ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1809
Practice Address - Country:US
Practice Address - Phone:517-437-4300
Practice Address - Fax:517-437-3898
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI22-20041OtherPHP OF SOUTH MICHIGAN
MI900C065080OtherBCBS OF MI
MIP00202329OtherPALMETTO GBA RR MEDICARE
MI364533227OtherCIGNA HEALTHCARE
MI4583930Medicaid
MI4991390001OtherADMINISTAR FEDERAL DMERC
MI900C065080OtherBCBS OF MI
MI4991390001OtherADMINISTAR FEDERAL DMERC