Provider Demographics
NPI:1235177114
Name:JOHNSON, TONICA VINETTA (MD)
Entity Type:Individual
Prefix:
First Name:TONICA
Middle Name:VINETTA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 HILLANDALE RD 1B #300
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27706
Mailing Address - Country:US
Mailing Address - Phone:216-509-1814
Mailing Address - Fax:
Practice Address - Street 1:1821 HILLANDALE RD 1B #300
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27706
Practice Address - Country:US
Practice Address - Phone:216-509-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87493207W00000X
NC200600411207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC808293OtherPARTNERS
NC0800905OtherUHC
P00340942OtherMEDICARE RAILROAD
NC142VKOtherBCBS NC
NC5904044Medicaid
NC188041OtherMEDCOST
NC808293OtherCOMMUNITY EYE CARE
NC0800905OtherMAMSI
NC1326265OtherAETNA
NC33400OtherOPTICARE
NCOPH182OtherPRIMAHEALTH
NC5904044Medicaid
NC1326265OtherAETNA