Individual
DR. KARL DAVID JOHANNESSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6300 N WICKHAM RD, UNIT 123, MELBOURNE, FL 32940-2028
(321) 751-7270
(321) 751-7769
Mailing address
PO BOX 120759, MELBOURNE, FL 32912-0759
(321) 298-7339
(321) 751-7769
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 2589
FL
Other
Enumeration date
07/16/2006
Last updated
07/08/2007
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