Johnson, Ellyn Victoria
Johnson, Ellyn Victoria is an individual health care provider with primary practice located at 5380 Us Highway 158 Suite 100, Advance NC 27006-6907. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Johnson, Ellyn Victoria can be contacted via phone (336) 940-2015.Contact Information
Primary practice address
5380 Us Highway 158 Suite 100
Advance NC 27006-6907
Phone: (336) 940-2015
Fax: (336) 940-2069
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1813 | North Carolina |
Profile Details
| NPI number | 1386694917 |
|---|---|
| LBN Legal business name | Johnson, Ellyn Victoria |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 12th, 2006 |
| Last updated | Sep 29th, 2010 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386694917 | NPPES |
| North Carolina | MEDICAID | 89093J4 |
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