Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1083942775 |
---|---|
Provider Name | Barbara L Johnson |
First Address | Fergus Falls, MN 56537-4007 |
Second Address | Fergus Falls, MN 56537-2756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2009 |
Last Update Date | 18/11/2009 |