Individual
DR. MELISSA L JOHNSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2800 S COLUMBIA RD STE 81, GRAND FORKS, ND 58201-6013
(701) 795-1441
Mailing address
2800 S COLUMBIA RD STE 81, GRAND FORKS, ND 58201-6013
(701) 795-1441
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
618
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2914
STATE LICENSE
MN
01
—
618
STATE LICENSE
ND
01
—
68-0560920
TAX IDENTIFICATION NUMBER
—
Enumeration date
10/03/2006
Last updated
12/08/2016
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