Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1174868780 |
---|---|
Provider Name | Leah Johnson |
First Address | Wimberley, TX 78676-2830 |
Second Address | Wimberley, TX 78676-2830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2012 |
Last Update Date | 07/12/2012 |