Organization
KIMBERLY JOHNSON OD LLC
Active
Other names
Gothenburg Eyecare & Optical
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY JOHNSON O.D. (MEMBER)
(308) 537-2020
Entity
Organization
Contact information
Practice address
902 AVENUE D, STE 102 B, GOTHENBURG, NE 69138-1900
(308) 537-2020
(308) 537-2280
Mailing address
902 AVENUE D, STE 102 B, GOTHENBURG, NE 69138-1900
(308) 537-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1232
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099868
MEDICARE GROUP PROVIDER NUMBER
NE
05
—
10025277400
—
NE
Enumeration date
07/18/2006
Last updated
06/08/2013
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