MEDICARE: ROGER K. JOHNSON 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	OEG001087	PA

General Provider Information

NPI Number	:	1649278763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER K. JOHNSON O.D.

Provider Business Mailing Address
First Line	:	1629 UNION AVE
Second Line	:	STE ONE
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2134
Country	:	US
Telephone Number	:	724-226-0444
Fax Number	:	724-226-0744

Provider Business Practice Location Address
First Line	:	1629 UNION AVE
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2134
Country	:	US
Telephone Number	:	724-226-0444
Fax Number	:	724-226-0744

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/07/2008

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