Organization
GARY E. JOHNSON, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY ELIJAH JOHNSON O.D. (PRESIDENT)
(701) 640-8773
Entity
Organization
Contact information
Practice address
3757 55TH AVE S, FARGO, ND 58104-6365
(701) 356-1717
(701) 356-1718
Mailing address
3757 55TH AVE S, FARGO, ND 58104-6365
(701) 356-1717
(701) 356-1718
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
607
ND
Other
Enumeration date
11/08/2010
Last updated
01/11/2011
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