Provider Demographics
NPI:1033126842
Name:JOHNSON, ROMAINE G (OD)
Entity Type:Individual
Prefix:DR
First Name:ROMAINE
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-820-6320
Mailing Address - Fax:610-820-8376
Practice Address - Street 1:1619 N 9TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6501
Practice Address - Country:US
Practice Address - Phone:570-422-6500
Practice Address - Fax:570-422-1010
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOE006415T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA430297Medicare PIN
T72755Medicare UPIN