Individual
CYNTHIA RUTH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4265 FALLON ST,, SUITE 1, BOZEMAN, MT 59718
(406) 587-0668
(406) 587-0396
Mailing address
4265 FALLON ST, SUITE 1, BOZEMAN, MT 59718-6756
(406) 587-0668
(406) 587-0396
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
530
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0480318
—
MT
Enumeration date
09/28/2006
Last updated
10/28/2008
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