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NPI Code Detail

MEDICARE: DR. ANTONIETTE JOHNSON DRIVER OD

MEDICARE: DR. ANTONIETTE JOHNSON DRIVER OD
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
1152W00000XOptometristOD 1814TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23154581OTHERTNBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1356348320
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTONIETTE JOHNSON DRIVER OD
Provider Business Mailing Address
First Line : PO BOX 1045
Second Line :
City : LEXINGTON
State : TN
Zip : 38351-1045
Country : US
Telephone Number : 731-968-1926
Fax Number : 731-968-1996
Provider Business Practice Location Address
First Line : 1009 E CHURCH ST
Second Line : SUITE A
City : LEXINGTON
State : TN
Zip : 38351-1947
Country : US
Telephone Number : 731-968-1926
Fax Number : 731-968-1996
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 05/26/2008

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