Healthcare Provider Details

I. General information

NPI: 1700827961
Provider Name (Legal Business Name): JOHNSON CITY EYE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MED TECH PKWY SUITE 1
JOHNSON CITY TN
37604-4004
US

IV. Provider business mailing address

PO BOX 5820
JOHNSON CITY TN
37602-5820
US

V. Phone/Fax

Practice location:
  • Phone: 423-929-2111
  • Fax: 423-929-0497
Mailing address:
  • Phone: 423-929-2111
  • Fax: 423-929-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD6474
License Number StateTN

VIII. Authorized Official

Name: DR. JOHN JOHNSON
Title or Position: M.D.
Credential: M.D.
Phone: 423-929-2111