Provider Demographics
NPI:1720148422
Name:GUNNING, JOHN (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GUNNING
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:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0453
Mailing Address - Country:US
Mailing Address - Phone:740-774-2106
Mailing Address - Fax:740-774-2107
Practice Address - Street 1:612 CENTRAL CENTER
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-774-2106
Practice Address - Fax:740-774-2107
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2944T466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000123255OtherBLUE CROSS BLUE SHIELD
OH0240902Medicaid
OH10114OtherCOORDINATED VISION CARE
OH2200203OtherUHC
OH314399798OtherTAX ID
OH2200202OtherUHC
OH314399798029OtherCARESOURCE
OH410011791Medicare ID - Type UnspecifiedRAILROAD
OHGU0155905Medicare ID - Type Unspecified
OH0240902Medicaid
OH410011787Medicare ID - Type UnspecifiedRAILROAD
OH0394510002Medicare ID - Type UnspecifiedADMINISTAR FEDERAL
OH2200202OtherUHC
OH0394510001Medicare ID - Type UnspecifiedADMINISTAR FEDERAL