Provider Demographics
NPI:1154414092
Name:POWER, JOHN DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:POWER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-7630
Mailing Address - Country:US
Mailing Address - Phone:618-997-5600
Mailing Address - Fax:618-993-2574
Practice Address - Street 1:3411 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-6478
Practice Address - Country:US
Practice Address - Phone:618-997-5600
Practice Address - Fax:618-993-2574
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0010084008OtherBLUE CROSS BLUE SHIELD #
IL0202910001Medicare NSC
ILT38802Medicare UPIN
IL0010084008OtherBLUE CROSS BLUE SHIELD #