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General NPI Number Information
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NPI Number | 1659324960
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Entity Type | Individual
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Provider Name | JOY GAYLE JOHNSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 2100 CALDWELL BLVD
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City | NAMPA
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State | ID
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Zip | 83651-1510
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Country | US
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Telephone | 208-465-5542
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Fax | 208-463-1724
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Provider Business Mailing Address
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Address Line | 622 E MAIN ST
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City | MIDDLETON
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State | ID
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Zip | 83644-3080
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Country | US
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Telephone | 208-585-9500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | ODP-742
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License Number State | ID
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