Individual
MR. TROY W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
310 W LOSEY ST, SCOTT AIR FORCE BASE, IL 62225-5250
(618) 256-7361
(618) 256-7516
Mailing address
310 W LOSEY ST, SCOTT AIR FORCE BASE, IL 62225-5250
(618) 256-7361
(618) 256-7516
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009783
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00321579
PALMETTO GBA
—
Enumeration date
01/22/2007
Last updated
10/03/2008
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