Provider Demographics
NPI:1538157516
Name:PRICE, JOHN R (OD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:PRICE
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 1:77 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3104
Mailing Address - Country:US
Mailing Address - Phone:740-773-8055
Mailing Address - Fax:740-773-8057
Practice Address - Street 1:77 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3104
Practice Address - Country:US
Practice Address - Phone:740-773-8055
Practice Address - Fax:740-773-8057
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0260275Medicaid
OH0420254Medicare ID - Type Unspecified
OH0260275Medicaid
OHT46789Medicare UPIN