Provider Demographics
NPI:1891868543
Name:NOVAK, JOHN J (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:NOVAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:36840 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1570
Mailing Address - Country:US
Mailing Address - Phone:440-934-1144
Mailing Address - Fax:440-548-1026
Practice Address - Street 1:36840 DETROIT RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1570
Practice Address - Country:US
Practice Address - Phone:440-934-1144
Practice Address - Fax:440-548-1026
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5565 T2479152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4309781Medicare PIN
AZV10815Medicare UPIN