Provider Demographics
NPI:1255566014
Name:JOHN A VAN EVERY OD
Entity type:Organization
Organization Name:JOHN A VAN EVERY OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN EVERY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:831-426-7172
Mailing Address - Street 1:550 WATER ST
Mailing Address - Street 2:J5
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4124
Mailing Address - Country:US
Mailing Address - Phone:831-426-7172
Mailing Address - Fax:831-426-0455
Practice Address - Street 1:550 WATER ST
Practice Address - Street 2:J5
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4124
Practice Address - Country:US
Practice Address - Phone:831-426-7172
Practice Address - Fax:831-426-0455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN A VAN EVERY OD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-22
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13611152W00000X
CAOPT5610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS00056100Medicare UPIN
CACD115AMedicare PIN