Provider Demographics
NPI:1841718897
Name:JOHNSON EYE CARE PLLC
Entity type:Organization
Organization Name:JOHNSON EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LARKIN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-428-0901
Mailing Address - Street 1:PO BOX 1692
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-6692
Mailing Address - Country:US
Mailing Address - Phone:830-428-0901
Mailing Address - Fax:210-698-0340
Practice Address - Street 1:1375 S MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2844
Practice Address - Country:US
Practice Address - Phone:830-428-0901
Practice Address - Fax:210-698-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5869TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty