Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | ODT968 | TN |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | ODT968 | TN |
NPI | 1225000540 |
---|---|
Provider Name | Dr. Warren S Johnson |
First Address | Memphis, TN 38117-3802 |
Second Address | Memphis, TN 38117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 01/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U48530 | (02) | TN |