Provider Demographics
NPI:1417115643
Name:ROBERT A JOHNS O.D.
Entity Type:Organization
Organization Name:ROBERT A JOHNS O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:209-667-6031
Mailing Address - Street 1:1001 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-2749
Mailing Address - Country:US
Mailing Address - Phone:209-667-6031
Mailing Address - Fax:
Practice Address - Street 1:1001 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-2749
Practice Address - Country:US
Practice Address - Phone:209-667-6031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4736TPL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
4736TPLOtherLICENSE #
942362663OtherTAX ID
CASD0047360Medicaid
CASD0047360Medicaid
CASD0047360Medicaid