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NPI Code Detail

MEDICARE: MICHAEL EDWARD JOHNSON O.D.

MEDICARE: MICHAEL EDWARD JOHNSON O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist0762NH

General Provider Information

NPI Number : 1245226976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL EDWARD JOHNSON O.D.
Provider Business Mailing Address
First Line : 605 LAFAYETTE RD
Second Line :
City : PORTSMOUTH
State : NH
Zip : 03801-5406
Country : US
Telephone Number : 603-629-0090
Fax Number : 603-629-0092
Provider Business Practice Location Address
First Line : 421 N MAIN ST
Second Line :
City : LEEDS
State : MA
Zip : 01053-9764
Country : US
Telephone Number : 413-345-1096
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 05/16/2023

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