Individual
DR. ANN M JOHANNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
695 W FOOTHILL BLVD, CLAREMONT, CA 91711-3490
(909) 625-7861
(909) 621-0742
Mailing address
695 W FOOTHILL BLVD, CLAREMONT, CA 91711-3490
(909) 625-7861
(909) 621-0742
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7500T
CA
152W00000X
Optometrist
WOP7500TPG
CA
152WC0802X
Corneal and Contact Management Optometrist
7500T
CA
152WP0200X
Pediatric Optometrist
7500T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WOP7500A
MEDICARE PTAN
—
Enumeration date
01/12/2007
Last updated
10/06/2014
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