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General NPI Number Information
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NPI Number | 1710079892
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Entity Type | Individual
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Provider Name | KARA DURICK JOHNSON OD
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Gender | Female
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 12771 RIVERDALE BLVD NW SUITE 103
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City | COON RAPIDS
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State | MN
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Zip | 55448-1262
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Country | US
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Telephone | 763-421-1220
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Fax | 763-421-1291
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Provider Business Mailing Address
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Address Line | 12771 RIVERDALE BLVD NW SUITE 103
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City | COON RAPIDS
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State | MN
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Zip | 55448-1262
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Country | US
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Telephone | 763-421-1220
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Fax | 763-421-1291
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2732
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License Number State | MN
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