MEDICARE: DR. WILLIAM HENRY LIVINGSTON O.D.

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	2719	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	460314	OTHER	MA	TUFTS
2	37962	OTHER	MA	DAVIS VISION
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	600000009	OTHER	MA	HARVARD PILGRIM
5	LIW15558	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1295812394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM HENRY LIVINGSTON O.D.

Provider Business Mailing Address
First Line	:	18 CYPRESS ST
Second Line	:
City	:	MARBLEHEAD
State	:	MA
Zip	:	01945-1926
Country	:	US
Telephone Number	:	781-639-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	336 WALNUT ST
Second Line	:
City	:	NEWTONVILLE
State	:	MA
Zip	:	02460-1923
Country	:	US
Telephone Number	:	617-964-9666
Fax Number	:	617-964-3380

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	11/17/2008

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