Individual
DR. TYLER J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3900 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416-2503
(952) 993-3150
Mailing address
3800 PARK NICOLLET BLVD, CREDENTIALING, ST LOUIS PARK, MN 55416-2527
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2358
MN
Other
Enumeration date
12/06/2005
Last updated
03/02/2012
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