MEDICARE: DR. JOHN E MCDONALD OD

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	7006T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3282	OTHER	CA	MESC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	999995883	OTHER	CA	VSP
4	086526	OTHER	CA	HEALTHNET
5	953859174	OTHER	CA	PRINCIPAL

General Provider Information

NPI Number	:	1609989508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN E MCDONALD OD

Provider Business Mailing Address
First Line	:	443 STILSON CANYON RD
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95928-9118
Country	:	US
Telephone Number	:	530-894-0443
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 N VILLA AVE
Second Line	:
City	:	WILLOWS
State	:	CA
Zip	:	95988-2607
Country	:	US
Telephone Number	:	530-934-3373
Fax Number	:	530-934-3522

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	02/25/2010

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