Provider Demographics
NPI:1649535253
Name:MORETTE, JOHNNY PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:PAUL
Last Name:MORETTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-7634
Mailing Address - Country:US
Mailing Address - Phone:561-856-2027
Mailing Address - Fax:
Practice Address - Street 1:1801 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 510
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-0911
Practice Address - Country:US
Practice Address - Phone:404-355-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist