Provider Demographics
NPI:1184009540
Name:JOHANSEN PRECISION EYE CARE LLC
Entity Type:Organization
Organization Name:JOHANSEN PRECISION EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-992-6386
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:NINETY SIX
Mailing Address - State:SC
Mailing Address - Zip Code:29666-0238
Mailing Address - Country:US
Mailing Address - Phone:864-223-6062
Mailing Address - Fax:864-538-6284
Practice Address - Street 1:214 WALLER AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2747
Practice Address - Country:US
Practice Address - Phone:864-543-3939
Practice Address - Fax:864-538-6284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty