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General NPI Number Information
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NPI Number | 1588651046
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Entity Type | Organization
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Legal Business Name | P & J REALTY
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6433 MONROE ST
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City | SYLVANIA
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State | OH
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Zip | 43560-1451
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Country | US
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Telephone | 419-885-5373
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Fax | 419-885-0504
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Provider Business Mailing Address
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Address Line | 6433 MONROE ST
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City | SYLVANIA
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State | OH
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Zip | 43560-1451
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Country | US
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Telephone | 419-885-5373
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Fax | 419-885-0504
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Authorized Official
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Title or Position | PARTNER
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Name | MR. ROBERT K EITH JOHNSTON
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Credential | OPTICIAN
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Telephone | 419-885-5373
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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 | 4076
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License Number State | OH
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