Organization
DR MATTHEW JOHANNES OD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW JOHANNES OD (OPTOMETRIST)
(620) 275-2222
Entity
Organization
Contact information
Practice address
410 N CAMPUS DR, GARDEN CITY, KS 67846-6134
(620) 275-2222
(620) 275-0829
Mailing address
410 N CAMPUS DR, GARDEN CITY, KS 67846-6134
(620) 275-2222
(620) 275-0829
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1552
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200259360A
—
KS
Enumeration date
07/30/2014
Last updated
04/14/2020
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