Organization
INDIGO VISION CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OWEN C JOHNSON O.D. (OWNER)
(843) 546-2244
Entity
Organization
Contact information
Practice address
302 CHURCH ST, GEORGETOWN, SC 29440-2406
(843) 546-2244
(843) 546-2255
Mailing address
302 CHURCH ST, GEORGETOWN, SC 29440-2406
(843) 546-2244
(843) 546-2255
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1279
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D12791
—
SC
01
—
P00151729
RAILROAD MEDICARE
SC
Enumeration date
09/10/2007
Last updated
07/09/2013
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