Individual
MARK D. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
310 W LOSEY ST, SCOTT AFB, IL 62225
(618) 256-6267
(618) 256-7931
Mailing address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-7361
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010751
IL
152W00000X
Optometrist
18002934A
IN
Other
Enumeration date
01/27/2006
Last updated
08/08/2018
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