Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | S-B35-TA-733 | AL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | S-B35-TA-733 | AL |
N | 152WP0200X | Pediatric Optomitrist | S-B35-TA-733 | AL |
NPI | 1225108103 |
---|---|
Provider Name | Dr. Jay Michael Johnson |
First Address | Alexandria, AL 36250-7205 |
Second Address | Gadsden, AL 35903-2708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 25/03/2013 |