Provider Demographics
NPI:1285705293
Name:MOHAN, WILLIAM JOHN (OD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:MOHAN
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 1:11071 HOWE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-9473
Mailing Address - Country:US
Mailing Address - Phone:716-759-7210
Mailing Address - Fax:716-759-7210
Practice Address - Street 1:1540 MILITARY RD
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4704
Practice Address - Country:US
Practice Address - Phone:716-298-5174
Practice Address - Fax:716-298-5176
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003771-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU81963Medicare UPIN