MEDICARE: MRS. EUNICE JOHNSON COSMETOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1023455474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EUNICE JOHNSON COSMETOLOGIST

Provider Business Mailing Address
First Line	:	1001 NE GREEN OAKS BLVD STE 109
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-2300
Country	:	US
Telephone Number	:	817-832-9013
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 NE GREEN OAKS BLVD STE 109
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-2300
Country	:	US
Telephone Number	:	817-277-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2013
Last Update Date	:	06/14/2022

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