Individual
DR. KYLE DALE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1104 E OHIO ST, CLINTON, MO 64735-2458
(660) 864-7116
(660) 864-7124
Mailing address
1516 S 5TH ST E, LOUISBURG, KS 66053-4186
(913) 244-8655
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1687
KS
152W00000X
Optometrist
Primary
2003014755
MO
Other
Enumeration date
08/08/2006
Last updated
02/07/2012
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