Healthcare Provider Details

I. General information

NPI: 1285990671
Provider Name (Legal Business Name): JOHNATHON ERIC DOWNING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 ROCKINGHAM AVE 204
BOWLING GREEN KY
42104-5840
US

IV. Provider business mailing address

420 E 3RD ST STE 603
LOS ANGELES CA
90013-1645
US

V. Phone/Fax

Practice location:
  • Phone: 270-799-2259
  • Fax: 270-495-1310
Mailing address:
  • Phone: 213-625-2694
  • Fax: 213-680-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA148366
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number49187
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: