Provider Demographics
NPI:1376282806
Name:LAWSON, JOHNATHAN BLAKE (OD)
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:BLAKE
Last Name:LAWSON
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 1:1717 MONTGOMERY HWY STE 117
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:205-623-3045
Practice Address - Street 1:1717 MONTGOMERY HWY STE 117
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1248
Practice Address - Country:US
Practice Address - Phone:205-985-0907
Practice Address - Fax:205-623-3045
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-F03-TA-C59152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist