# JOHNSON VISION DEVELOPMENT CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235401514
- **Authorized official:** DR. PAULA JOHNSON-WYATT OD (OWNER/OPTOMETRIST)
- **Authorized official phone:** (731) 660-1100

## Contact information

- **Practice address:** 1012 GREYSTONE SQUARE, JACKSON, TN 38305
- **Practice address phone:** (731) 660-1100
- **Practice address fax:** (731) 660-0688
- **Mailing address:** 1012 GREYSTONE SQUARE, JACKSON, TN 38305
- **Mailing address phone:** (731) 660-1100
- **Mailing address fax:** (731) 660-0688

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152WP0200X | Pediatric Optometrist | — | NULL | Yes |
| 152WP0200X | Pediatric Optometrist | — | — | Yes |
| 152WV0400X | Vision Therapy Optometrist | — | NULL | — |
| 152WV0400X | Vision Therapy Optometrist | — | — | — |

## Other

- **Enumeration date:** 02/02/2012
- **Last updated:** 09/25/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5440904 | — | TN |
| 05 | — | Q028220 | — | TN |