Provider Demographics
NPI:1487752150
Name:BACKES, JOHN F (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:BACKES
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 1:6250 SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:W MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3722
Mailing Address - Country:US
Mailing Address - Phone:321-952-6731
Mailing Address - Fax:
Practice Address - Street 1:845 PALM BAY RD NE
Practice Address - Street 2:INSIDE WM VISION CENTER
Practice Address - City:W MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8400
Practice Address - Country:US
Practice Address - Phone:321-722-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist