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NPI Code Detail

MEDICARE: DR. TRAVIS M. JOHNSON O.D.

MEDICARE:  DR. TRAVIS M. JOHNSON  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2763MN
2152W00000XOptometrist3158TN

General Provider Information

NPI Number : 1003890609
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRAVIS M. JOHNSON O.D.
Provider Business Mailing Address
First Line : 2125 ROCK SPRINGS MIDLAND RD
Second Line :
City : CHRISTIANA
State : TN
Zip : 37037-5357
Country : US
Telephone Number : 651-230-3554
Fax Number :
Provider Business Practice Location Address
First Line : 140 JOE B JACKSON PKWY
Second Line :
City : MURFREESBORO
State : TN
Zip : 37127-7228
Country : US
Telephone Number : 615-203-9165
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2005
Last Update Date : 08/08/2022

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