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Individual

TIMOTHY J. JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1623 CENTRAL AVE, LOS ALAMOS, NM 87544-3018
(505) 662-5444
(505) 662-6109
Mailing address
8801 HORIZON BLVD NE, SUITE 360, ALBUQUERQUE, NM 87113-1533
(505) 828-4923
(505) 213-0103

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
458
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
F5946
NM
01
NM00P444
BC BS OF NM
NM
Enumeration date
10/24/2005
Last updated
04/20/2008
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