Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1700X | Ocularist | 5001000030 | MI |
N | 156FX1700X | Ocularist | DEPARTMENT OF LABOR | IL |
NPI | 1659371094 |
---|---|
Provider Name | James P Johnston |
First Address | Michigan City, IN 46360-7354 |
Second Address | Michigan City, IN 46360-7354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 09/07/2007 |