Organization
DALE JOHNSON OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE JOHNSON OD (MANAGER)
(906) 632-2020
Entity
Organization
Contact information
Practice address
724 CEDAR ST, SAULT SAINTE MARIE, MI 49783-2410
(906) 632-2020
Mailing address
724 CEDAR ST, SAULT SAINTE MARIE, MI 49783-2410
(906) 632-2020
Taxonomy
Speciality
Code
Description
License number
State
152WV0400X
Vision Therapy Optometrist
Primary
4901002749
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P31680
MEDICARE PLUS BLUE
—
05
—
4578107
—
MI
01
—
900A710230
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/16/2006
Last updated
07/29/2015
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