Provider Demographics
NPI:1811182017
Name:JOHN W TAYLOR OD PC
Entity type:Organization
Organization Name:JOHN W TAYLOR OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-437-4300
Mailing Address - Street 1:59 BARRY ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:59 BARRY ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1809
Practice Address - Country:US
Practice Address - Phone:517-437-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4583930Medicaid
MI0C00026OtherBCBS
MI200000005009OtherPHPSM
MI=========OtherCIGNA
MI0C06508Medicare PIN
MIP00905711Medicare PIN
MI200000005009OtherPHPSM
MIT32847Medicare UPIN
MI0C00026OtherBCBS
MI=========OtherCIGNA