Healthcare Provider Details

I. General information

NPI: 1225108103
Provider Name (Legal Business Name): JAY MICHAEL JOHNSON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 RAINBOW DR STE 1
GADSDEN AL
35901-5392
US

IV. Provider business mailing address

236 BARRINGTON CIR
ALEXANDRIA AL
36250-7205
US

V. Phone/Fax

Practice location:
  • Phone: 256-543-8886
  • Fax: 256-546-1094
Mailing address:
  • Phone: 256-892-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberS-B35-TA-733
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberS-B35-TA-733
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-B35-TA-733
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: