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Organization

ACTIVE LIFE EYE CARE, OD, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRENT B. JOHNSON O.D. (OPTOMETRIST)
(336) 404-6235
Entity
Organization

Contact information

Practice address
415 W ACADEMY ST, MADISON, NC 27025-2005
(336) 404-6235
Mailing address
415 W ACADEMY ST, MADISON, NC 27025-2005
(336) 404-6235

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary

Other

Enumeration date
07/07/2015
Last updated
01/11/2016
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