Basic Information
| Provider Information | |||||||||
| NPI: | 1649308792 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOHN H. FAIN, OD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 N TOWN EAST BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751504736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722792020 | ||||||||
| FaxNumber: | 9722792637 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 N TOWN EAST BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751504736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722792020 | ||||||||
| FaxNumber: | 9722792637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 09/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | FAIN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9722792020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | O.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2364TG | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.