Provider Demographics
NPI:1538175492
Name:CLASSE, JOHN G (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:CLASSE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1716 UNIVERSITY BLVD
Mailing Address - Street 2:HBP G080A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0010
Mailing Address - Country:US
Mailing Address - Phone:205-934-4748
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:1716 UNIVERSITY BLVD
Practice Address - Street 2:HBP G080A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0010
Practice Address - Country:US
Practice Address - Phone:205-934-4748
Practice Address - Fax:205-934-6755
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-409-TA-178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1586048OtherLOUISIANA MEDICAID
AL51059866OtherBLUE CROSS BLUE SHIELD
AL000059866Medicaid
AL410021235OtherMEDICARE RAILROAD
ALT69162OtherVIVA HEALTH
MS05054867OtherMISSISSIPPI MEDICAID
T69162Medicare UPIN
AL000059866Medicaid