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General NPI Number Information
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NPI Number | 1952656589
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Entity Type | Organization
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Legal Business Name | MARK JOHNSON, O.D., PLLC
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 6155 EASTEX FWY SUITE #699
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City | BEAUMONT
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State | TX
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Zip | 77706-6718
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Country | US
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Telephone | 409-892-4790
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Fax |
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Provider Business Mailing Address
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Address Line | 6155 EASTEX FWY SUITE #699
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City | BEAUMONT
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State | TX
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Zip | 77706-6718
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Country | US
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Telephone | 409-892-4790
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MARK ALAN JOHNSON
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Credential | O.D.
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Telephone | 409-892-4790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | TX4495T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | TX4495T
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 156FC0800X
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Taxonomy Name | Contact Lens Technician/Technologist
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License Number | TX4495T
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number | TX4495T
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TX4495
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License Number State | TX
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