Individual
KEVIN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2709 S KOKE MILL RD, SPRINGFIELD, IL 62711
(217) 698-9477
(217) 698-9474
Mailing address
2709 S KOKE MILL RD, SPRINGFIELD, IL 62711
(217) 698-9477
(217) 698-9474
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.010236
IL
Other
Enumeration date
06/25/2009
Last updated
10/23/2019
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