Provider Demographics
NPI:1184836306
Name:YORK, JOHNNY (OD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:YORK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15601
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27113
Mailing Address - Country:US
Mailing Address - Phone:336-760-1291
Mailing Address - Fax:336-760-1295
Practice Address - Street 1:930 HANES MALL BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-760-1291
Practice Address - Fax:336-760-1295
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1096152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1096OtherSTATE LICENSE NUMBER
NC0998GOtherBCBS PROVIDER NUMBER
NCMY1268223OtherDEA NUMBER
NC1096OtherSTATE LICENSE NUMBER