Mallory Jayne Johnson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

6490 Issued in FL

Practice address

590 Medical Center Rd
BLDG 36065
Fort Cavazos, TX 76544

Phone

(254) 288-8000

NPI assigned

Aug 13, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1306677059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2308 LOS ARBOLES LN",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767111188",
            "telephone_number": "254-366-5526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 MEDICAL CENTER RD",
            "address_2": "BLDG 36065",
            "city": "FORT CAVAZOS",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "254-288-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MALLORY",
        "middle_name": "JAYNE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-13",
        "last_updated": "2024-08-13",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "6490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cody Jackson, DO
• Danette M. Jackson, DO
• Mark Lawrence Jacques, M.D.
• Woohyuck Jang, DO
• Dae Min Jeon, DDS
• Mitchell Johnson
• Stacey Lanette Johnson, D.C.
• Travanti N Jones
• Brett Kaplan, MD
• Erika Frances Karsch

• Optometrist in Fort Cavazos, TX
• Providers in Fort Cavazos, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.