Organization
EAGLE VISION EYE CARE OPTOMETRIC GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL WAYNE JOHNSON OD (OPTOMETRIST/OWNER)
(916) 231-0034
Entity
Organization
Contact information
Practice address
5777 GREENBACK LN., STE 100, SACRAMENTO, CA 95841-2013
(916) 231-0034
(916) 231-0038
Mailing address
5777 GREENBACK LN., STE 100, SACRAMENTO, CA 95841-2013
(916) 231-0034
(916) 231-0038
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CT764A
—
CA
Enumeration date
12/31/2007
Last updated
08/29/2011
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