Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1023584091 |
---|---|
Provider Name | Adam Louis Johnson |
First Address | West Creek, NJ 08092-2845 |
Second Address | Manahawkin, NJ 08050-3069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2018 |
Last Update Date | 17/10/2018 |