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Individual

DR. BRENT BUNDY JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
714 HIGHWAY ST, MADISON, NC 27025-1508
(336) 427-2020
(336) 427-2022
Mailing address
5783 EAST LAKE RD, ROMULUS, NY 14541
(315) 283-8928

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1830
NC
152W00000X
Optometrist
OET 008758
PA
152W00000X
Optometrist
TUV 006646
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000160882
EXCELLUS (3221)
NY
01
000926375001
HEALTHNOW (3221)
NY
01
44281
SPECTERA (1945)
PA
01
44324
DAVIS (3221)
NY
01
44519
SPECTERA (1976)
NY
01
44944
DAVIS (2528)
PA
01
44945
DAVIS (1945)
PA
01
46709
SPECTERA (2992)
NY
01
49273
DAVIS (2992)
NY
01
55760
DAVIS (1976)
NY
01
JO 1368847
PENN BLUE SHIELD
PA
01
JO 1634168
HIGHMARK (2992)
NY
Enumeration date
09/25/2006
Last updated
10/26/2023
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