Individual
JACKIE NGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2011 N ROAN ST, JOHNSON CITY, TN 37601-3130
(423) 610-7155
Mailing address
1201 FREDERICKSBURG DR, JOHNSON CITY, TN 37604-6377
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3535
TN
Other
Enumeration date
07/01/2019
Last updated
07/01/2019
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