Provider Demographics
NPI:1023584091
Name:JOHNSON, ADAM LOUIS (OPTICIAN)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:LOUIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 INMAN CT
Mailing Address - Street 2:
Mailing Address - City:WEST CREEK
Mailing Address - State:NJ
Mailing Address - Zip Code:08092-2845
Mailing Address - Country:US
Mailing Address - Phone:732-674-1899
Mailing Address - Fax:
Practice Address - Street 1:399 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3069
Practice Address - Country:US
Practice Address - Phone:732-674-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician