Individual
DR. ROBIN LEE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
418 S POPLAR, SUITE 5, CENTRALIA, IL 62801
(618) 533-4929
(618) 533-4929
Mailing address
418 S POPLAR, SUITE 5, CENTRALIA, IL 62801
(618) 533-4929
(618) 533-4929
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007927
IL
152W00000X
Optometrist
047207927
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007927
—
IL
Enumeration date
06/10/2006
Last updated
08/12/2008
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