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NPI Code Detail

MEDICARE: DR. WILLIAM LEE JOHNSON O.D.

MEDICARE: DR. WILLIAM LEE 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
1152W00000XOptometrist634MS

General Provider Information

NPI Number : 1386733301
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM LEE JOHNSON O.D.
Provider Business Mailing Address
First Line : 10730 SAINT FRANCIS DR
Second Line :
City : PHILADELPHIA
State : MS
Zip : 39350-2171
Country : US
Telephone Number : 601-656-2432
Fax Number :
Provider Business Practice Location Address
First Line : 1002 W BEACON ST
Second Line :
City : PHILADELPHIA
State : MS
Zip : 39350-3204
Country : US
Telephone Number : 601-656-2432
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 07/08/2007

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