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General NPI Number Information
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NPI Number | 1184700825
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Entity Type | Organization
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Legal Business Name | JOHNSON EYE CLINIC, P.A
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 702 10TH ST
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City | WORTHINGTON
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State | MN
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Zip | 56187-2767
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Country | US
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Telephone | 507-376-5535
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Fax | 507-376-4805
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Provider Business Mailing Address
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Address Line | 702 10TH ST PO BOX 726
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City | WORTHINGTON
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State | MN
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Zip | 56187-2767
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Country | US
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Telephone | 507-376-5535
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Fax | 507-376-4805
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | WALLACE S JOHNSON
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Credential | O.D.
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Telephone | 507-376-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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