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General NPI Number Information
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NPI Number | 1568632941
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Entity Type | Organization
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Legal Business Name | JEFFREY C. JOHNSON
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 7960 W RIFLEMAN STREET SUITE 150
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-377-8899
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Fax | 208-321-1952
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Provider Business Mailing Address
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Address Line | 7960 W RIFLEMAN STREET SUITE 150
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-377-8899
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Fax | 208-321-1952
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Authorized Official
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Title or Position | MANAGER
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Name | JEFFREY C JOHNSON
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Credential | O.D.
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Telephone | 208-377-8899
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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 | ODP843
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License Number State | ID
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