Individual
RANDALL RICHARD JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
102 E KIMBERLY RD, DAVENPORT, IA 52806-5922
(563) 386-1950
(563) 386-1021
Mailing address
102 E KIMBERLY RD, DAVENPORT, IA 52806-5922
(563) 386-1950
(563) 386-1021
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02142
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37150
BCBS
—
01
—
J01642089
CLARITY VISION
—
Enumeration date
04/22/2006
Last updated
07/08/2007
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