Individual
TAMMY L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
1339 COMMERCE AVE, SUITE 101, LONGVIEW, WA 98632-3738
(360) 425-4647
(360) 578-2496
Mailing address
1339 COMMERCE AVE, SUITE 101, LONGVIEW, WA 98632-3738
(360) 425-4647
(360) 578-2496
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO1822
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2026979
—
WA
01
—
212744
212744
—
01
—
LO22314
22314
—
01
—
WA0851
0851
—
Enumeration date
02/12/2007
Last updated
07/08/2007
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