MEDICARE: JARRETT ANN JOHNSON A PROFESSIONAL OPTOMETRY CORPORATION

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	152WC0802X	Corneal and Contact Management Optometrist	1128-133T	LA
2	152W00000X	Optometrist	1128-113T	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700058567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JARRETT ANN JOHNSON A PROFESSIONAL OPTOMETRY CORPORATION

Provider Business Mailing Address
First Line	:	1530 N BROAD ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-2334
Country	:	US
Telephone Number	:	504-943-0070
Fax Number	:	504-943-0072

Provider Business Practice Location Address
First Line	:	1530 N BROAD ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-2334
Country	:	US
Telephone Number	:	504-943-0070
Fax Number	:	504-943-0072

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JARRETT ANN JOHNSON
Credential	:	OD,MPH
Telephone Number	:	504-943-0070

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	08/18/2015

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