JOHNSON VISION DEVELOPMENT CENTER LLC NPI 1235401514

NPI Information

  • NPI: 1235401514
  • Provider Name: JOHNSON VISION DEVELOPMENT CENTER, LLC
  • Classification: Optometrist - 152WP0200X
  • Specialization: Pediatrics
  • Entity Type: Organization
  • Address: 1012 GREYSTONE SQUARE
    JACKSON, TN
    ZIP 38305
  • Phone: (731) 660-1100

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NPI Details

JOHNSON VISION DEVELOPMENT CENTER, LLC is a pediatrics optometrist in Jackson, TN. The provider is optometrists who work in Pediatrics are concerned with the prevention, development, diagnosis, and treatment of visual problems in children. JOHNSON VISION DEVELOPMENT CENTER, LLC NPI is 1235401514. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1012 GREYSTONE SQUARE
JACKSON, TN
ZIP 38305
Phone: (731) 660-1100
Fax: (731) 660-0688

The provider's authorized official is Paula Johnson-wyatt .
The authorized official title is Owner/optometrist and has the following contact phone number (731) 660-1100.

The enumeration date for this NPI number is 2/2/2012 and was last updated on 9/25/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1152WV0400XOptometristVision TherapyNo
2152WP0200XOptometristPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1Q028220MEDICAIDTENNESSEE
25440904MEDICAIDTENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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