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General NPI Number Information
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NPI Number | 1891983235
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Entity Type | Organization
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Legal Business Name | LEONIDAS A. JOHNSON, O.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 06/30/2017
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Provider Practice Location Address
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Address Line | 4403 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90037-2413
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Country | US
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Telephone | 323-778-7798
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Fax | 323-778-7190
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Provider Business Mailing Address
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Address Line | PO BOX 4434
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City | DIAMOND BAR
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State | CA
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Zip | 91765-0434
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Country | US
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Telephone | 714-828-7798
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Fax | 323-778-7190
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEONIDAS A. JOHNSON
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Credential | O.D.
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Telephone | 714-828-7798
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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 | 8254 TLG
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License Number State | CA
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