Organization
BRYAN L. JOHNSON, O.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN L JOHNSON O.D. (OPTOMETRIST)
(580) 371-2020
Entity
Organization
Contact information
Practice address
506 E 24TH ST, TISHOMINGO, OK 73460-3214
(580) 371-2020
(580) 371-2122
Mailing address
506 E 24TH ST, TISHOMINGO, OK 73460-3214
(580) 371-2020
(580) 371-2122
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
446700083-001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
04/16/2007
Last updated
07/21/2022
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