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Individual
DR. JOHN C PACK
Active
Individual
DR. JOHN C PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9684T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200547724
TAX ID
—
01
—
912870
IMED
—
05
—
SD0096840
—
CA
Enumeration date
05/02/2006
Last updated
06/18/2008
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