MEDICARE: LEAH JOHNSON

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
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1174868780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH JOHNSON

Provider Business Mailing Address
First Line	:	5024 BROADWAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-5708
Country	:	US
Telephone Number	:	512-529-4932
Fax Number	:

Provider Business Practice Location Address
First Line	:	5024 BROADWAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-5708
Country	:	US
Telephone Number	:	512-396-1500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2012
Last Update Date	:	08/29/2022

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Directions to “ LEAH JOHNSON ” Practice Location

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