Individual
ROGER DEAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
702 10TH ST, WORTHINGTON, MN 56187-2767
(507) 376-5535
(507) 376-4805
Mailing address
702 10TH ST, WORTHINGTON, MN 56187-2767
(507) 376-5535
(507) 376-4805
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1545
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
454523100
—
MN
Enumeration date
07/11/2006
Last updated
03/03/2015
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