Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 7500T | CA |
N | 152W00000X | Optometrist | WOP7500TPG | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 7500T | CA |
N | 152WP0200X | Pediatric Optomitrist | 7500T | CA |
NPI | 1114078771 |
---|---|
Provider Name | Dr. Ann M Johannsen |
First Address | Claremont, CA 91711-3490 |
Second Address | Claremont, CA 91711-3490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 06/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U34034 | (02) | CA |
WOP7500A | MEDICARE PTAN (01) | |
WY040 | (02) | CA |