Provider Demographics
NPI:1992775712
Name:PEARSON, JOHN D (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:PEARSON
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 1:3200 S RURAL RD
Mailing Address - Street 2:#1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3870
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 S RURAL RD
Practice Address - Street 2:#1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3870
Practice Address - Country:US
Practice Address - Phone:480-966-0522
Practice Address - Fax:480-966-0650
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ49142301Medicaid
AZ49142301Medicaid