Provider Demographics
NPI:1629399910
Name:DUKES, JOHNNA (ABOC)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:
Last Name:DUKES
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 18TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1163
Mailing Address - Country:US
Mailing Address - Phone:712-336-4401
Mailing Address - Fax:712-336-4403
Practice Address - Street 1:1306 18TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1163
Practice Address - Country:US
Practice Address - Phone:712-336-4401
Practice Address - Fax:712-336-4403
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA155315156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician