MEDICARE: DR. JULIAN C ARCHER 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	2672	CO
2	152W00000X	Optometrist	OL-047	GU

General Provider Information

NPI Number	:	1558519363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIAN C ARCHER O.D.

Provider Business Mailing Address
First Line	:	736 ROUTE 4 STE 202
Second Line	:
City	:	SINAJANA
State	:	GU
Zip	:	96910-3368
Country	:	US
Telephone Number	:	671-989-4747
Fax Number	:	671-989-4743

Provider Business Practice Location Address
First Line	:	1234 N MARINE CORPS DR STE 202
Second Line	:
City	:	TAMUNING
State	:	GU
Zip	:	96913-4307
Country	:	US
Telephone Number	:	671-989-4747
Fax Number	:	671-989-4743

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

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	11/11/2022

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