Healthcare Provider Details

I. General information

NPI: 1437224276
Provider Name (Legal Business Name): JOHNNA D HOBBS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 DUPONT AVE S SUITE 200
BLOOMINGTON MN
55431-3100
US

IV. Provider business mailing address

9801 DUPONT AVE S SUITE 425
BLOOMINGTON MN
55431-3100
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-5800
  • Fax: 952-567-6156
Mailing address:
  • Phone: 952-888-5800
  • Fax: 952-567-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2669
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2669
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: