Individual
DR. GABRIEL JAY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
300 LYCOMING MALL CIR, SUITE 264, PENNSDALE, PA 17756-8072
(570) 546-8315
(570) 546-0312
Mailing address
918 W 4TH ST, APT. 1E, WILLIAMSPORT, PA 17701-5804
(484) 213-7757
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001770
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA1770
EYEMED
PA
Enumeration date
03/01/2007
Last updated
07/08/2007
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