MEDICARE: BRYCE S JOHNSON OD

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
1	152W00000X	Optometrist	OPT702	NM

General Provider Information

NPI Number	:	1952897019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYCE S JOHNSON OD

Provider Business Mailing Address
First Line	:	1124 10TH ST
Second Line	:
City	:	ALAMOGORDO
State	:	NM
Zip	:	88310-6414
Country	:	US
Telephone Number	:	575-434-1200
Fax Number	:	575-437-3947

Provider Business Practice Location Address
First Line	:	850 W FLORIDA ST
Second Line	:
City	:	DEMING
State	:	NM
Zip	:	88030-4558
Country	:	US
Telephone Number	:	575-544-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	07/02/2018

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Directions to “ BRYCE S JOHNSON OD” Practice Location

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