Individual
KENNETH N JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
179 FLANDERS RD, NIANTIC, CT 06357-1206
(860) 691-0279
Mailing address
179 FLANDERS RD, NIANTIC, CT 06357-1206
(860) 739-0279
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
CT0001217
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001217
—
CT
05
—
1326280512
—
CT
Enumeration date
11/17/2020
Last updated
11/17/2020
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