Individual
MARIA SMITH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2100 W CORNWALLIS DR STE J, GREENSBORO, NC 27408-7015
(336) 288-3937
(336) 288-8177
Mailing address
PO BOX 207261, DALLAS, TX 75320-7261
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1938
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1938
LICENCE
NC
01
—
OD00003838
LICENCE
WA
01
—
ODP100059
LICENCE
ID
01
—
OPT002326
GA
GA
Enumeration date
06/27/2006
Last updated
04/21/2021
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