Most Relevant Information
Provider Data
| NPI Number: | 1003032970 |
| Provider Name: | DELESIE PETRIC JOHNSON O.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | 4493T |
Most Important Dates
| Enumeration Date: | 04/18/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
9307 FOXGROVE WAY
SAN ANTONIO
TX
782514107
Practice Location Phone/Fax
| Phone: | 2105235276 |
| Fax: | 2105235276 |
Provider Mailing Location
9307 FOXGROVE WAY
SAN ANTONIO
TX
782514107
Provider Mailing Phone/Fax
| Phone: | 2105235276 |
| Fax: | 2105235276 |