Individual
DR. MICHAEL JAMES JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1458
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1234N
BC/BS NC
—
01
—
4105287
MAMSI
—
01
—
5131920001
MEDICARE NFC
NC
01
—
5399513
AETNA
—
05
—
891234N
—
NC
01
—
D6432
MEDCOST
—
Enumeration date
09/26/2006
Last updated
10/26/2010
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