Provider Demographics
NPI:1720794845
Name:JOHNSON EYE CENTER PLLC
Entity type:Organization
Organization Name:JOHNSON EYE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-656-2432
Mailing Address - Street 1:1120 E MAIN ST STE 22
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2375
Mailing Address - Country:US
Mailing Address - Phone:601-656-2432
Mailing Address - Fax:601-650-0069
Practice Address - Street 1:1120 E MAIN ST STE 22
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2375
Practice Address - Country:US
Practice Address - Phone:601-656-2432
Practice Address - Fax:601-650-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25509536OtherVSP