MEDICARE: DR. ROMAINE G JOHNSON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OE006415T	PA

General Provider Information

NPI Number	:	1033126842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROMAINE G JOHNSON OD

Provider Business Mailing Address
First Line	:	1251 S CEDAR CREST BLVD
Second Line	:	SUITE 307
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-6205
Country	:	US
Telephone Number	:	610-820-6320
Fax Number	:	610-820-8376

Provider Business Practice Location Address
First Line	:	1619 N 9TH ST
Second Line	:	SUITE 1
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6501
Country	:	US
Telephone Number	:	570-422-6500
Fax Number	:	570-422-1010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	09/06/2013

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