Healthcare Provider Details

I. General information

NPI: 1346928751
Provider Name (Legal Business Name): VICTORIA JO JOHNSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SHRINER ST
VERMILLION SD
57069-1155
US

IV. Provider business mailing address

1703 ARNOLD PALMER LN
ELK POINT SD
57025-2313
US

V. Phone/Fax

Practice location:
  • Phone: 605-624-2020
  • Fax:
Mailing address:
  • Phone: 605-670-0578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number130794
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003533
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3966
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number823
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: