Provider Demographics
NPI:1811996325
Name:MORTON, JOHN W (OD,PSC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MORTON
Suffix:
Gender:M
Credentials:OD,PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2607
Mailing Address - Country:US
Mailing Address - Phone:606-329-1404
Mailing Address - Fax:606-325-7446
Practice Address - Street 1:1201 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2607
Practice Address - Country:US
Practice Address - Phone:606-329-1404
Practice Address - Fax:606-325-7446
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY803DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1418243OtherUNITED MINE WORKERS ASSOC
KY5315095OtherAETNA
KYK115OtherBC BS OF KY
KY000000047400OtherANTHEM BLUE
KY410003978OtherPALMETTO RAILROAD MEDICAR
KY77008035Medicaid
KY000000047400OtherANTHEM BLUE
KYT54655Medicare UPIN