JOHNSON VISION DEVELOPMENT CENTER, LLC (NPI# 1235401514) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235401514 |
| Entity Type | Organization |
| Organization Name | JOHNSON VISION DEVELOPMENT CENTER, LLC |
| Practice Address |
1012 Greystone Square Jackson TN 38305 |
| Practice Telephone | 7316601100 |
| Practice Fax Number | 7316600688 |
| Mailing Telephone | 7316601100 |
| Mailing Fax Number | 7316600688 |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2019-09-25 |
| Authorized Official Name | DR. PAULA JOHNSON-WYATT (OWNER/OPTOMETRIST) |
| Authorized Official Telephone | 7316601100 |
| Authorized Official Credential | OD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152WV0400X |
Optometrist Specialization: Vision Therapy |
Eye and Vision Services Providers | ||
| Y | 152WP0200X |
Optometrist Specialization: Pediatrics |
Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | Q028220 | 05 | |
| TN | 5440904 | 05 |
| Street Address |
1012 GREYSTONE SQUARE |
| City | JACKSON |
| State | TN |
| Zip Code | 38305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477501088 | Paula Johnson-wyatt | Optometrist | 1012 Greystone Square, Jackson, TN 38305 | 2006-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427656818 | Kimaya Jelks | Specialist | 1869 45 Hwy Bypass, Suite 2b, Jackson, TN 38305 | 2020-10-16 |
| 1821600578 | Maame Obeng | Pharmacist | 3144 North Highland Avenue, Jackson, TN 38305 | 2020-08-22 |
| 1700361904 | James Cowie | Psychologist | 156c West University Pkwy, Jackson, TN 38305 | 2018-10-03 |
| 1700372109 | Chad Zawacki | Physician Assistant | 147 North Star Drive, Jackson, TN 38305 | 2018-07-09 |
| 1104323070 | Golden Years Adult Day Care | Clinic/Center | 155 Carriage Dr Suite A, Jackson, TN 38305 | 2018-04-09 |
| 1245754563 | Tanika Annette Gillard | Massage Therapist | 4 Hampton Ln, Jackson, TN 38305 | 2017-07-28 |
| 1316488117 | Lakisha T Ingram | Counselor | 168 Greencastle Dr, Jackson, TN 38305 | 2017-03-13 |
| 1619421567 | D & L Wellness Inc | Community/Behavioral Health | 154 Carriage House Dr., Jackson, TN 38305 | 2016-08-09 |
| 1649637638 | Advance Choice Home Care LLC | In Home Supportive Care | 1028 Ashport Rd., Jackson, TN 38305 | 2016-01-21 |
| 1942666151 | Neurohealth Solutions Inc. | Clinic/Center | 174 Murray Guard Dr. Suite E, Jackson, TN 38305 | 2016-01-05 |
| Find all providers in zip 38305 | ||||
| Taxonomy Code | 152WP0200X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Specialization | Pediatrics |
| Optometrists who work in Pediatrics are concerned with the prevention, development, diagnosis, and treatment of visual problems in children. |
| Notes: Source: American Optometric Association [1/1/2009: added definition, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477501088 | Paula Johnson-wyatt | Optometrist | 1012 Greystone Square, Jackson, TN 38305 | 2006-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942801907 | Jacob Andrew Boehme | Optometrist | 1245 Madison Ave, Memphis, TN 38104-2211 | 2020-11-05 |
| 1689179939 | Caitlyn Suzanne Reynolds | Optometrist | 3601 The Vanderbilt Clinic, Nashville, TN 37232-3026 | 2018-03-28 |
| 1750818571 | Elizabeth Murray | Optometrist | 930 Madison Ave Ste 400, Memphis, TN 38103-7400 | 2017-05-11 |
| 1467550871 | Lori Ann F Kehler | Optometrist | 3601 The Vanderbilt Clinic, Nashville, TN 37232-5100 | 2006-09-20 |
| 1164437836 | Angela Lee Ann Dabbs | Optometrist | 1760 W Morris Blvd, Morristown, TN 37813-2834 | 2006-07-30 |
| 1780664706 | Mary Grace Summers | Optometrist | 8045 Club Pkwy, Cordova, TN 38016-5977 | 2006-01-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.