Provider Demographics
NPI:1548265879
Name:MAROHN, JOHN W (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:MAROHN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2848 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3352
Mailing Address - Country:US
Mailing Address - Phone:269-428-3300
Mailing Address - Fax:269-428-5005
Practice Address - Street 1:2848 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3352
Practice Address - Country:US
Practice Address - Phone:269-428-3300
Practice Address - Fax:269-428-5005
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3186238Medicaid
MIM25910002Medicare PIN
MIU37073Medicare UPIN