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General NPI Number Information
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NPI Number | 1780742908
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Entity Type | Organization
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Legal Business Name | JOHNSON EYECARE, P.C.
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 1875 MIDDLE RD
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City | BETTENDORF
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State | IA
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Zip | 52722-3203
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Country | US
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Telephone | 563-359-4446
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Fax | 563-359-0381
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Provider Business Mailing Address
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Address Line | 1875 MIDDLE RD
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City | BETTENDORF
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State | IA
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Zip | 52722-3203
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Country | US
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Telephone | 563-359-4446
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Fax | 563-359-0381
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | DR. RANDALL R JOHNSON
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Credential | O.D.
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Telephone | 563-359-4446
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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 | IA02142
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License Number State | IA
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