Individual
MR. BRYAN LOWELL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3630 11TH AVE NW, ROCHESTER, MN 55901-4276
(507) 288-2457
(507) 288-1299
Mailing address
3630 11TH AVE NW, ROCHESTER, MN 55901-4276
(507) 288-2457
(507) 288-1299
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2090
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01017733
PREFERRED ONE
—
01
—
2201134
MEDICA CHOICE SELECT
—
01
—
4C934J0
BCBS OF MN
MN
05
—
549823700
—
MN
01
—
HP44093
HEALTH PARTNERS
—
Enumeration date
12/01/2005
Last updated
05/28/2009
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