Provider Demographics
NPI:1548345689
Name:JOHNSON & JOHNSON DOCTORS OF OPTOMETRY, PA
Entity type:Organization
Organization Name:JOHNSON & JOHNSON DOCTORS OF OPTOMETRY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-6464
Mailing Address - Street 1:2800 N ELM ST
Mailing Address - Street 2:BIGGS PARK MALL
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3000
Mailing Address - Country:US
Mailing Address - Phone:910-738-6464
Mailing Address - Fax:910-738-4944
Practice Address - Street 1:2800 N ELM ST
Practice Address - Street 2:BIGGS PARK MALL
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3000
Practice Address - Country:US
Practice Address - Phone:910-738-6464
Practice Address - Fax:910-738-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1327152W00000X
NCNC2207152W00000X
NCNC1368152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890183YMedicaid
NC890945HMedicaid
NC890945YMedicaid
NC410033212OtherRAIL ROAD MEDICARE
NC890945YMedicaid
NC890183YMedicaid
NC2467199CMedicare PIN
NCU30637Medicare UPIN
NC2469959Medicare ID - Type UnspecifiedPRACTICE GROUP #
NC2467951BMedicare PIN