Provider Demographics
NPI:1487953774
Name:JOHN W MORTON, O.D.,P.S.C.
Entity type:Organization
Organization Name:JOHN W MORTON, O.D.,P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-329-1404
Mailing Address - Street 1:1201 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2607
Mailing Address - Country:US
Mailing Address - Phone:606-329-1404
Mailing Address - Fax:606-325-7446
Practice Address - Street 1:1201 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2607
Practice Address - Country:US
Practice Address - Phone:606-329-1404
Practice Address - Fax:606-325-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY803DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008035Medicaid
KY0512010001Medicare NSC
KYT54655Medicare UPIN
KY77008035Medicaid