MEDICARE: DR. JOHN WINSTON ARCHIBALD 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	2163	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	540909060	OTHER		RAILROAD MEDICARE
5	0127570001	OTHER		MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	713846	OTHER	MA	TUFTS HEALTH
4	W16179	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1295729903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WINSTON ARCHIBALD O.D.

Provider Business Mailing Address
First Line	:	476 MASS AVE
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-5106
Country	:	US
Telephone Number	:	781-648-2342
Fax Number	:	781-648-2346

Provider Business Practice Location Address
First Line	:	476 MASS AVE
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-5106
Country	:	US
Telephone Number	:	781-648-2342
Fax Number	:	781-648-2346

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	09/21/2009

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Directions to “ DR. JOHN WINSTON ARCHIBALD O.D.” Practice Location

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