Organization
BRENDON J JOHNSON, OD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENDON J JOHNSON O.D. (OWNER/DOCTOR)
(309) 347-5989
Entity
Organization
Contact information
Practice address
2611 BROADWAY ST, PEKIN, IL 61554-2501
(309) 347-5989
(309) 347-4315
Mailing address
2988 COURT ST, PEKIN, IL 61554-6229
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009489
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009489
—
IL
Enumeration date
01/07/2008
Last updated
03/04/2020
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