Organization
JOHNSON EYE CLINIC, P.A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALLACE S JOHNSON O.D. (CHIEF FINANCIAL OFFICER)
(507) 376-5535
Entity
Organization
Contact information
Practice address
702 10TH ST, WORTHINGTON, MN 56187-2767
(507) 376-5535
(507) 376-4805
Mailing address
702 10TH ST, PO BOX 726, WORTHINGTON, MN 56187-2767
(507) 376-5535
(507) 376-4805
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4C624JO
BLUECROSSBLUESHIELD
MN
Enumeration date
10/27/2006
Last updated
08/22/2020
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