MEDICARE: CHESTER COUNTY OPTICIANS, INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000897526	OTHER	PW	HIGHMARK BLUE SHIELD

General Provider Information

NPI Number	:	1013926146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESTER COUNTY OPTICIANS, INC

Provider Business Mailing Address
First Line	:	923 PAOLI PIKE
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4527
Country	:	US
Telephone Number	:	610-692-8300
Fax Number	:	610-692-6007

Provider Business Practice Location Address
First Line	:	923 PAOLI PIKE
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4527
Country	:	US
Telephone Number	:	610-692-8300
Fax Number	:	610-692-6007

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. DANIEL P JOHNSON
Credential	:	OD
Telephone Number	:	610-692-8300

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	03/11/2014

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