MEDICARE: MR. JOHN G OLIVER MD

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	24024	NC

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
2	64063	OTHER		BCBS

General Provider Information

NPI Number	:	1467443184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN G OLIVER MD

Provider Business Mailing Address
First Line	:	PO BOX 636
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-0636
Country	:	US
Telephone Number	:	336-838-5121
Fax Number	:	336-667-5756

Provider Business Practice Location Address
First Line	:	408 8TH ST
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-4167
Country	:	US
Telephone Number	:	336-838-5121
Fax Number	:	336-667-5756

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	12/07/2009

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Practice Fax: 336-667-5756

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