Provider Demographics
NPI:1891827911
Name:JOHNSON, JOHN
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W GRAY ST
Mailing Address - Street 2:STE 130
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7129
Mailing Address - Country:US
Mailing Address - Phone:405-360-5505
Mailing Address - Fax:
Practice Address - Street 1:330 W GRAY ST
Practice Address - Street 2:STE 130
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7129
Practice Address - Country:US
Practice Address - Phone:405-360-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1061070001Medicare NSC