| Johnson Eye Center | |
|
1120 E Main St Ste 22 Philadelphia MS 39350-2375 | |
| (601) 656-2432 | |
| (601) 650-0069 |
| Full Name | Johnson Eye Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1120 E Main St Ste 22, Philadelphia, Mississippi |
| Authorized Official Name and Position | William Lee Johnson (OWNER) |
| Authorized Official Contact | 6016562432 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Johnson Eye Center 1120 E Main St Ste 22 Philadelphia MS 39350-2375 Ph: (601) 656-2432 | Johnson Eye Center 1120 E Main St Ste 22 Philadelphia MS 39350-2375 Ph: (601) 656-2432 |
| NPI Number | 1720794845 |
|---|---|
| Provider Enumeration Date | 01/24/2023 |
| Last Update Date | 05/08/2023 |
| Certification Date | 05/08/2023 |
| Medicare PECOS PAC ID | 6002266046 |
|---|---|
| Medicare Enrollment ID | O20240103001131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720794845 | NPI | - | NPPES |
| 25509536 | Other | MS | VSP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | William Lee Johnson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1386733301 PECOS PAC ID: 6608286083 Enrollment ID: I20201113002455 |
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