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Organization subpart
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Provider details

NPI number
Authorized official
THOMAS J JOHNSON O.D. (VICE PRESIDENT)
(928) 773-9697
Entity
Organization

Contact information

Practice address
4800 N 22ND ST, PHOENIX, AZ 85016-4701
(602) 955-1000
(602) 508-4830
Mailing address
1030 N SAN FRANCISCO ST, SUITE 130, FLAGSTAFF, AZ 86001-3252
(928) 779-0500
(928) 779-6350

Taxonomy

Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
AZ1128
AZ

Other

Enumeration date
01/24/2007
Last updated
01/04/2008
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