Johanna Mauk, O.D.
Optometrist in Gaylord, MI. Individual provider (NPI-1).
NPI number1720439102
StatusActive
Last updated in NPPESJun 27, 2016
Details
- NPI
- 1720439102
- Entity type
- Individual (NPI-1)
- Name
- Johanna Mauk
- Credential
- O.D.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 27, 2016
- Last updated
- Jun 27, 2016
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - OPTOMETRY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 4901004978 | MI | Yes |
Practice location
829 W Main St Ste EGaylord, MI 49735-1998
Phone 989-732-6261
Mailing address
829 W Main St Ste EGaylord, MI 49735-1998
Phone 989-732-6261
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 25 Optometrist providers in Gaylord · All 714 providers in Gaylord
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