Provider Demographics
NPI:1205169653
Name:TODD, JO'ANN (OD)
Entity type:Individual
Prefix:
First Name:JO'ANN
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 N BREAZEALE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-1121
Mailing Address - Country:US
Mailing Address - Phone:919-658-2020
Mailing Address - Fax:919-658-0487
Practice Address - Street 1:104 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-8968
Practice Address - Country:US
Practice Address - Phone:910-814-2020
Practice Address - Fax:919-639-8508
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2138152W00000X
VA0618001788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist