Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | ||
N | 156FX1202X | Optometric Technician | ||
Y | 156FX1800X | Optician |
NPI | 1467086868 |
---|---|
Provider Name | Jonathan Johnson |
First Address | Dallas, TX 75248-4073 |
Second Address | Dallas, TX 75248-4073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2020 |
Last Update Date | 25/02/2020 |