Provider Demographics
NPI:1306996194
Name:JOHNS, ROBERT A (OD, FAAO, INC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:JOHNS
Suffix:
Gender:M
Credentials:OD, FAAO, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 COLORADO AVENUE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-3406
Mailing Address - Country:US
Mailing Address - Phone:209-667-6031
Mailing Address - Fax:209-667-4512
Practice Address - Street 1:1001 COLORADO AVENUE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3406
Practice Address - Country:US
Practice Address - Phone:209-667-6031
Practice Address - Fax:209-667-4512
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4736TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942362663OtherTAX ID #
CASD0047360Medicaid
CASD0047360Medicaid
CASD0047360Medicare ID - Type Unspecified
CASD0047360Medicaid