Organization
CYNTHIA G JOHNSON OD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CYNTHIA G JOHNSON OD (OPTOMETRIST PRESIDENT)
(262) 886-4629
Entity
Organization
Contact information
Practice address
2500 MAYFAIR RD, DEAN AND FLETCHER, MILWAUKEE, WI 53226
(414) 771-8999
Mailing address
6641 MARINER DR, # 1, RACINE, WI 53406
(262) 886-4629
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2246035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38576600
—
WI
Enumeration date
04/11/2007
Last updated
08/22/2020
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