Healthcare Provider Details

I. General information

NPI: 1982737607
Provider Name (Legal Business Name): ROBERT I JOHNSON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 E HORSETOOTH RD BLDG 4
FORT COLLINS CO
80525-3155
US

IV. Provider business mailing address

373 W DRAKE RD SUITE 3
FORT COLLINS CO
80526-2881
US

V. Phone/Fax

Practice location:
  • Phone: 970-377-3111
  • Fax:
Mailing address:
  • Phone: 970-223-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPT2383
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberOPT2383
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT2383
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOPT2383
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: