Provider Demographics
NPI:1588707723
Name:JOHNSON FAMILY EYECARE
Entity type:Organization
Organization Name:JOHNSON FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD, FAAO
Authorized Official - Phone:724-537-5358
Mailing Address - Street 1:600 LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1426
Mailing Address - Country:US
Mailing Address - Phone:724-537-5358
Mailing Address - Fax:724-537-9826
Practice Address - Street 1:600 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1426
Practice Address - Country:US
Practice Address - Phone:724-537-5358
Practice Address - Fax:724-537-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA094799OtherMEDCARE GROUP
PA0603430001Medicare NSC
PA102275UMZMedicare PIN
PAT28613Medicare UPIN