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General NPI Number Information
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NPI Number | 1891813176
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Entity Type | Organization
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Legal Business Name | THOMAS K. JOHNSON OPTOMETRIST
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 641 SPRING ST
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City | PASO ROBLES
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State | CA
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Zip | 93446-2838
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Country | US
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Telephone | 805-226-0400
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Fax | 805-238-4047
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Provider Business Mailing Address
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Address Line | 641 SPRING ST
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City | PASO ROBLES
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State | CA
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Zip | 93446-2838
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Country | US
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Telephone | 805-226-0400
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Fax | 805-238-4047
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS K JOHNSON
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Credential | O.D.
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Telephone | 805-226-0400
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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 | 5157T
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License Number State | CA
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