MEDICARE: DIANA DEE JOHNSON RDO

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	156FX1800X	Optician	298	NV

General Provider Information

NPI Number	:	1437643335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA DEE JOHNSON RDO

Provider Business Mailing Address
First Line	:	3839 N CARSON ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-1935
Country	:	US
Telephone Number	:	775-297-4453
Fax Number	:	775-841-2020

Provider Business Practice Location Address
First Line	:	3839 N CARSON ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-1935
Country	:	US
Telephone Number	:	775-297-4453
Fax Number	:	775-841-2020

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

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	06/14/2018

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Directions to “ DIANA DEE JOHNSON RDO” Practice Location

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