Individual
DOUGLAS W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
675 SCHOOL ST, HILLSBORO, IL 62049-1530
(217) 532-5044
(217) 532-2109
Mailing address
675 SCHOOL ST, HILLSBORO, IL 62049-1530
(217) 532-5044
(217) 532-2109
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007103
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007103
—
IL
01
—
L28789
MEDICARE ID-TYPE UNSPECIFIED
IL
Enumeration date
04/07/2006
Last updated
09/10/2010
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