Individual
DR. BRENT WARREN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
700 SE CHKALOV DR, SUITE 5, VANCOUVER, WA 98683-5202
(360) 256-0612
(360) 896-5503
Mailing address
700 SE CHKALOV DR, SUITE 5, VANCOUVER, WA 98683-5202
(360) 256-0612
(360) 896-5503
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1650TX
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2003523
—
WA
Enumeration date
01/22/2007
Last updated
03/15/2008
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