=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801975826
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW DANIEL JOHNSON O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 11/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3050 E LOHMAN AVE STE F
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88011-8256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-521-4053
-----------------------------------------------------
Fax | 575-522-5592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3050 E LOHMAN AVE STE F
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88011-8256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-521-4053
-----------------------------------------------------
Fax | 575-522-5592
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 544
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------