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General NPI Number Information
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NPI Number | 1871718965
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Entity Type | Organization
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Legal Business Name | BRYAN L. JOHNSON, O.D. P.C.
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 506 E 24TH ST
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City | TISHOMINGO
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State | OK
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Zip | 73460-3214
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Country | US
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Telephone | 580-371-2020
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Fax | 580-371-2122
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Provider Business Mailing Address
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Address Line | 506 E 24TH ST
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City | TISHOMINGO
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State | OK
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Zip | 73460-3214
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Country | US
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Telephone | 580-371-2020
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Fax | 580-371-2122
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. BRYAN L JOHNSON
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Credential | O.D.
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Telephone | 580-371-2020
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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 | OK
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