Organization
TERRY JOHNSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DENISE E. BURCH (OFFICE MANAGER)
(989) 636-7200
Entity
Organization
Contact information
Practice address
5908 EASTMAN AVE, MIDLAND, MI 48640-6748
(989) 636-7200
(989) 636-7210
Mailing address
5908 EASTMAN AVE, MIDLAND, MI 48640-6748
(989) 636-7200
(989) 636-7210
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
4901002282
MI
332B00000X
Durable Medical Equipment & Medical Supplies
4901002282
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1547439
—
MI
Enumeration date
04/26/2010
Last updated
04/06/2022
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