Organization
RSJOHNSON OD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN S JOHNSON OD (OWNER)
(208) 241-9145
Entity
Organization
Contact information
Practice address
4240 YELLOWSTONE AVE, CHUBBUCK, ID 83202-2420
(208) 241-9145
Mailing address
12482 DALLIN RD, POCATELLO, ID 83202-5073
(208) 241-9145
(208) 238-2069
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184653403
—
ID
Enumeration date
06/25/2021
Last updated
06/25/2021
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