Healthcare Provider Details

I. General information

NPI: 1639432974
Provider Name (Legal Business Name): PAULA LYNN JOHNS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 301 NORTH ZUNI HOSPITAL
ZUNI NM
87327
US

IV. Provider business mailing address

PO BOX 467 EYE CLINIC
ZUNI NM
87327-0467
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-7485
  • Fax: 505-782-7589
Mailing address:
  • Phone: 505-782-7485
  • Fax: 505-782-7589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1714
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: