Individual
DR. THOMAS NELSON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTOMETRIST
Contact information
Practice address
2824 W DIVISION ST, SAINT CLOUD, MN 56301-3800
(320) 253-2020
(320) 251-6885
Mailing address
2824 W DIVISION ST, SAINT CLOUD, MN 56301-3800
(320) 253-2020
(320) 251-6885
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
LD22510000
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-2552298
PREFERRED CARE (TAX ID)
MN
01
—
21-00495
MA-MEDICA DISPENSING
MN
01
—
22-02504
MEDICA
MN
01
—
22-255-2298
AETNA (TAX ID)
MN
01
—
3C169JO
BCBSM ID#
MN
05
—
428318000
—
MN
01
—
48457
DAVIS VISION
MN
01
—
539263
OPTICHOICE (BCBSM)
MN
01
—
85742JO
BCBSM CLINIC ID #
MN
01
—
P00303198 /GP DE6004
RAIL ROAD MEDICARE
MN
01
—
SPECTARA
17760
MN
Enumeration date
09/26/2006
Last updated
10/29/2008
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