Provider Demographics
NPI:1457526600
Name:JOHN DOUGLAS EMCH OD
Entity type:Organization
Organization Name:JOHN DOUGLAS EMCH OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:EMCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-445-0436
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502
Mailing Address - Country:US
Mailing Address - Phone:419-445-0436
Mailing Address - Fax:419-445-2697
Practice Address - Street 1:700 STRYKER ST
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502
Practice Address - Country:US
Practice Address - Phone:419-445-0436
Practice Address - Fax:419-445-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3230T421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0314403Medicaid
OH0428361Medicare PIN
OHT46818Medicare UPIN
OH0468210002Medicare NSC