Individual
AMY LYN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ABO
Contact information
Practice address
11505 ULYSSES ST NE, BLAINE, MN 55434-4239
(763) 354-5399
Mailing address
11505 ULYSSES ST NE, BLAINE, MN 55434-4239
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
202432
MN
Other
Enumeration date
01/08/2024
Last updated
01/08/2024
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