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General NPI Number Information
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NPI Number | 1346464955
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Entity Type | Organization
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Legal Business Name | DR. JAY D. JOHNSON, OPTOMETRIST, PLC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 1120 RAMBLING OAKS DRIVE
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City | NORMAN
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State | OK
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Zip | 73072
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Country | US
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Telephone | 405-701-4114
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Fax | 405-801-3689
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Provider Business Mailing Address
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Address Line | 1120 RAMBLING OAKS DRIVE
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City | NORMAN
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State | OK
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Zip | 73072
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Country | US
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Telephone | 405-701-4114
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Fax | 405-801-3689
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAY D. JOHNSON
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Credential | O.D.
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Telephone | 405-701-4114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1085
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License Number State | OK
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