Individual
DR. RYAN SCOTT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4240 YELLOWSTONE AVE, CHUBBUCK, ID 83202-2420
(208) 238-2020
(208) 238-2069
Mailing address
12482 DALLIN RD, POCATELLO, ID 83202-5073
(208) 241-9145
(208) 238-2069
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-1037
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807153600
—
ID
Enumeration date
06/30/2006
Last updated
07/19/2021
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