Individual
SAMUEL DAVID JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
204 IONA ST, FAIRMONT, NC 28340-1616
(910) 628-8316
(910) 628-5642
Mailing address
PO BOX 648, FAIRMONT, NC 28340-0648
(910) 628-8316
(910) 628-5642
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2337
NC
Other
Enumeration date
09/16/2013
Last updated
09/16/2013
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