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NPI Code Detail

MEDICARE: DR. MILLIE A JOHNSON O.D.

MEDICARE:  DR. MILLIE A JOHNSON  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1327NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10934FOTHERNCBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184682312
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MILLIE A JOHNSON O.D.
Provider Business Mailing Address
First Line : PO BOX 397
Second Line :
City : BENSON
State : NC
Zip : 27504-0397
Country : US
Telephone Number : 919-894-2001
Fax Number : 919-894-3190
Provider Business Practice Location Address
First Line : 304 E MAIN ST
Second Line :
City : BENSON
State : NC
Zip : 27504-1511
Country : US
Telephone Number : 919-894-2001
Fax Number : 919-894-3190
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 06/18/2012

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