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General NPI Number Information
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NPI Number | 1568647790
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Entity Type | Organization
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Legal Business Name | BRENDON J JOHNSON, OD, PC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 2611 BROADWAY ST
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City | PEKIN
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State | IL
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Zip | 61554-2501
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Country | US
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Telephone | 309-347-5989
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Fax | 309-347-4315
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Provider Business Mailing Address
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Address Line | 2988 COURT ST
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City | PEKIN
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State | IL
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Zip | 61554-6229
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. BRENDON J JOHNSON
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Credential | O.D.
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Telephone | 309-347-5989
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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 | 046009489
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License Number State | IL
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