MEDICARE: WILLIAM R JOHNSTON OPTICIAN

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	156FX1800X	Optician	N/A

General Provider Information

NPI Number	:	1548253768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R JOHNSTON OPTICIAN

Provider Business Mailing Address
First Line	:	7324 CALUMET AVE
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46324-2620
Country	:	US
Telephone Number	:	219-931-3314
Fax Number	:

Provider Business Practice Location Address
First Line	:	7324 CALUMET AVE
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46324-2620
Country	:	US
Telephone Number	:	219-931-3314
Fax Number	:

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	02/29/2008

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