| Samantha Johnson O.d., Pc | |
|
4545 E 3rd St Ste 105 Los Angeles CA 90022-1656 | |
| (323) 261-3098 | |
| Not Available |
| Full Name | Samantha Johnson O.d., Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4545 E 3rd St Ste 105, Los Angeles, California |
| Authorized Official Name and Position | Samantha Johnson (PRESIDENT) |
| Authorized Official Contact | 6198202756 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samantha Johnson O.d., Pc 4545 E 3rd St Ste 105 Los Angeles CA 90022-1656 Ph: (619) 820-2756 | Samantha Johnson O.d., Pc 4545 E 3rd St Ste 105 Los Angeles CA 90022-1656 Ph: (323) 261-3098 |
| NPI Number | 1760101588 |
|---|---|
| Provider Enumeration Date | 08/24/2022 |
| Last Update Date | 08/24/2022 |
| Medicare PECOS PAC ID | 4981089398 |
|---|---|
| Medicare Enrollment ID | O20220921003199 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760101588 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Samantha M Johnson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1144774928 PECOS PAC ID: 7618263047 Enrollment ID: I20160909002002 |
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