Individual
DR. WALLACE SCOTT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
775 BUCKSKIN AVE W, PILLAGER, MN 56473-2509
(218) 746-2020
(218) 520-0654
Mailing address
775 BUCKSKIN AVE W STE 1, PILLAGER, MN 56473-2509
(218) 746-2020
(218) 520-0654
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2196
MN
152WC0802X
Corneal and Contact Management Optometrist
2196
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
63372
MPIN
MN
05
—
970525200
—
MN
Enumeration date
03/21/2006
Last updated
07/24/2025
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