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Organization

JEFFREY C. JOHNSON

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JEFFREY C JOHNSON O.D. (MANAGER)
(208) 377-8899
Entity
Organization

Contact information

Practice address
7960 W RIFLEMAN STREET, SUITE 150, BOISE, ID 83704
(208) 377-8899
(208) 321-1952
Mailing address
7960 W RIFLEMAN STREET, SUITE 150, BOISE, ID 83704
(208) 377-8899
(208) 321-1952

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP843
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1378685
MEDICARE GROUP ID#
ID
05
1568632941
ID
Enumeration date
03/03/2008
Last updated
04/04/2018
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