MEDICARE: DR. JOHN WILLIAM HALLISEY 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	G25366	CA

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

General Provider Information

NPI Number	:	1467500686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN WILLIAM HALLISEY M.D.

Provider Business Mailing Address
First Line	:	1270 PEACH ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2856
Country	:	US
Telephone Number	:	805-541-1342
Fax Number	:	805-541-5836

Provider Business Practice Location Address
First Line	:	1270 PEACH ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2856
Country	:	US
Telephone Number	:	805-541-1342
Fax Number	:	805-541-5836

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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