Individual
BRENT DANIEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
435 S GROVE ST, SUITE 2, BLUE EARTH, MN 56013-2604
(507) 526-2222
(507) 526-3927
Mailing address
PO BOX 36, BLUE EARTH, MN 56013-0036
(507) 526-2222
(507) 526-3927
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2195
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060225600
—
MN
Enumeration date
08/24/2005
Last updated
02/08/2013
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