Individual
MR. GARY JOHANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
1460 CORNERSTONE BLVD, DAYTONA BEACH, FL 32117-7174
(386) 760-3330
(386) 274-2051
Mailing address
1460 CORNERSTONE BLVD, DAYTONA BEACH, FL 32117-7174
(386) 760-3330
(386) 274-2051
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
01914
FL
Other
Enumeration date
06/01/2023
Last updated
06/01/2023
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