1740325307 NPI number — JOHN T ARCHER & ASSOCIATES INC

Table of content: (NPI 1740325307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740325307 NPI number — JOHN T ARCHER & ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN T ARCHER & ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PREMIER VISION GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740325307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINSTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45865-1121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-628-3017
Provider Business Mailing Address Fax Number:
419-628-8208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINSTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45865-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-628-3017
Provider Business Practice Location Address Fax Number:
419-628-8208
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HECKMAN
Authorized Official First Name:
CHRISTA
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
419-628-3017

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  06015853 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2600868 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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