Provider Demographics
NPI:1023455474
Name:JOHNSON, EUNICE (COSMETOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 NE GREEN OAKS BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-2300
Mailing Address - Country:US
Mailing Address - Phone:817-832-9013
Mailing Address - Fax:
Practice Address - Street 1:1001 NE GREEN OAKS BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-2300
Practice Address - Country:US
Practice Address - Phone:817-277-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management