Individual
JACLYN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14239 W BELL RD STE 216, SURPRISE, AZ 85374-2482
(602) 955-1000
Mailing address
4129 S MEADOWS RD APT 1628, SANTA FE, NM 87507-2719
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT.0003337
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
418504
—
AZ
Enumeration date
07/26/2017
Last updated
11/14/2018
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