Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1464 | KS |
N | 152W00000X | Optometrist | T03242 | MO |
NPI | 1003881863 |
---|---|
Provider Name | Dr. Jennifer P Johnson |
First Address | Kansas City, MO 64121-9241 |
Second Address | Olathe, KS 66061-7200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 19/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
410039582 | RAILROAD MEDICARE (01) | KS |
U57922 | (02) |