Provider Demographics
NPI:1902889595
Name:MAGILL, JOHN TUCKER (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TUCKER
Last Name:MAGILL
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 1:222 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1728
Mailing Address - Country:US
Mailing Address - Phone:740-474-3860
Mailing Address - Fax:740-474-3865
Practice Address - Street 1:222 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1728
Practice Address - Country:US
Practice Address - Phone:740-474-3860
Practice Address - Fax:740-474-3865
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3035T825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0260864Medicaid
OH0670750001Medicare NSC
OH0480122Medicare PIN
OH0480122Medicare UPIN