Provider Demographics
NPI:1770551129
Name:WACHTER, JOHN B JR (OD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:WACHTER
Suffix:JR
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 1:9375 66TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782
Mailing Address - Country:US
Mailing Address - Phone:727-541-4469
Mailing Address - Fax:727-546-9661
Practice Address - Street 1:9375 66TH STREET NORTH
Practice Address - Street 2:EYE ASSOCIATES OF PINELLAS
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782
Practice Address - Country:US
Practice Address - Phone:727-541-4469
Practice Address - Fax:727-546-9661
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0002459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62043900Medicaid
U27672Medicare UPIN
FL62043900Medicaid