Individual
T K JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5908 EASTMAN AVE, MIDLAND, MI 48640-6748
(989) 636-7200
(989) 636-7210
Mailing address
5908 EASTMAN AVE, MIDLAND, MI 48640-6748
(989) 636-7200
(989) 636-7210
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002282
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1547439
—
MI
01
—
9OOE665040
BLUE CROSS BLUE SHIELD
MI
Enumeration date
09/22/2006
Last updated
03/19/2012
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