Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1043691959 |
---|---|
Provider Name | Lisa C Johnston |
First Address | Benson, NC 27504-6105 |
Second Address | Benson, NC 27504-6105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2015 |
Last Update Date | 15/09/2015 |