Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901004866 | MI |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 4901004866 | MI |
N | 152WP0200X | Pediatric Optomitrist | 4901004866 | MI |
NPI | 1124320817 |
---|---|
Provider Name | Dr. Andrew James Johnson |
First Address | Chelsea, MI 48118 |
Second Address | Chelsea, MI 48118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2010 |
Last Update Date | 18/08/2021 |