Provider Demographics
NPI:1740325307
Name:JOHN T ARCHER & ASSOCIATES INC
Entity type:Organization
Organization Name:JOHN T ARCHER & ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-628-3017
Mailing Address - Street 1:208 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-1121
Mailing Address - Country:US
Mailing Address - Phone:419-628-3017
Mailing Address - Fax:419-628-8208
Practice Address - Street 1:208 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-1121
Practice Address - Country:US
Practice Address - Phone:419-628-3017
Practice Address - Fax:419-628-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06015853152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2600868Medicaid