MEDICARE: DR. JOHN SULLIVAN M.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	207W00000X	Ophthalmology Physician	G12933	CA

General Provider Information

NPI Number	:	1285605303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN SULLIVAN M.D.

Provider Business Mailing Address
First Line	:	220 MERIDIAN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2903
Country	:	US
Telephone Number	:	408-869-3400
Fax Number	:	408-947-7972

Provider Business Practice Location Address
First Line	:	220 MERIDIAN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2903
Country	:	US
Telephone Number	:	408-869-3400
Fax Number	:	408-947-7972

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	04/29/2020

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