Individual
DR. SAMUEL LEE JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
214 WALLER AVE, GREENWOOD, SC 29646-2747
(864) 992-6386
Mailing address
300 BYPASS 25 NE, GREENWOOD, SC 29646
(864) 992-6386
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1872
SC
Other
Enumeration date
06/17/2015
Last updated
03/27/2019
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