Individual
DR. BRIAN S JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6695 W RIO GRANDE AVE, KENNEWICK, WA 99336-3301
(509) 736-0826
(509) 735-6868
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
(360) 242-3008
(360) 807-7687
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00003721
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011663
—
WA
05
—
1487761748
—
ID
05
—
33287775
—
NM
01
—
410047917
RAIL ROAD MEDICARE
WA
01
—
410047918
RAIL ROAD MEDICARE
WA
01
—
410048907
RAIL ROAD MEDICARE
ID
Enumeration date
08/24/2006
Last updated
12/07/2020
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