Active NPI
John J. Conrad, OD
- Optometrist
- East Liverpool, OH
National Provider Identifier
1306983515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3525
- Practice address
- 16761 St. Clair Ave
Suite I
East Liverpool, OH 43920-9400 - Phone
- (330) 386-9313
- Fax
- (330) 386-9353
- NPI assigned
- Jan 30, 2007
- Last updated
- Jun 15, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3525 | OH | Primary |
Addresses
Primary practice location
16761 St. Clair Ave
Suite I
East Liverpool, OH 43920-9400
Mailing address
16761 St. Clair Ave
Suite I
East Liverpool, OH 43920-9400
Phone (330) 386-9313
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0472368 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3525 | OH | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245024000000",
"number": "1306983515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16761 ST. CLAIR AVE",
"address_2": "SUITE I",
"city": "EAST LIVERPOOL",
"state": "OH",
"postal_code": "439209400",
"telephone_number": "330-386-9313",
"fax_number": "330-386-9353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16761 ST. CLAIR AVE",
"address_2": "SUITE I",
"city": "EAST LIVERPOOL",
"state": "OH",
"postal_code": "439209400",
"telephone_number": "330-386-9313",
"fax_number": "330-386-9353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONRAD",
"first_name": "JOHN",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2009-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "3525",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0472368",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Liverpool, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.