Individual
GRANT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2043 COLLEGE WAY, FOREST GROVE, OR 97116-1756
(503) 352-2020
Mailing address
1811 NW COUCH ST, APT. 412, PORTLAND, OR 97209-2143
(503) 858-0129
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3378ATI
OR
Other
Enumeration date
07/20/2010
Last updated
07/20/2010
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