Individual
DR. HEIDI L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.,
Contact information
Practice address
2822 VENTURE DR, MARQUETTE, MI 49855-8631
(906) 228-4401
(906) 225-0460
Mailing address
2822 VENTURE DR, MARQUETTE, MI 49855-8631
(906) 228-4401
(906) 225-0460
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003354
MI
152WC0802X
Corneal and Contact Management Optometrist
4901003354
MI
152WL0500X
Low Vision Rehabilitation Optometrist
4901003354
MI
152WP0200X
Pediatric Optometrist
4901003354
MI
152WS0006X
Sports Vision Optometrist
4901003354
MI
152WV0400X
Vision Therapy Optometrist
4901003354
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3115352
—
MI
01
—
900E265343
BLUE CROSS BLUE SHIELD OF
MI
Enumeration date
09/07/2005
Last updated
04/10/2024
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