Provider Demographics
NPI:1639432974
Name:JOHNS, PAULA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:LYNN
Last Name:JOHNS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:EYE CLINIC
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-0467
Mailing Address - Country:US
Mailing Address - Phone:505-782-7485
Mailing Address - Fax:505-782-7589
Practice Address - Street 1:ROUTE 301 NORTH
Practice Address - Street 2:ZUNI HOSPITAL
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327
Practice Address - Country:US
Practice Address - Phone:505-782-7485
Practice Address - Fax:505-782-7589
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM988559251Medicaid
NM988559251Medicaid