Provider Demographics
NPI:1144486887
Name:JOHN E. KOHLER O.D. INC.
Entity type:Organization
Organization Name:JOHN E. KOHLER O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:8584-818-9941
Mailing Address - Street 1:465 W OCEAN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3632
Mailing Address - Country:US
Mailing Address - Phone:858-481-8994
Mailing Address - Fax:
Practice Address - Street 1:465 W OCEAN VIEW AVE
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3632
Practice Address - Country:US
Practice Address - Phone:858-481-8994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6194374461OtherVISION SERVICE PLAN
CA6194374461OtherTRI WEST
CA06001 (4461)OtherMEDICAL EYE SERVICES
CACA5419OtherEYE MED
CA6194374461OtherTRI WEST
CAAU380Medicare PIN