Provider Demographics
NPI:1245234921
Name:JOHNSON, CURTISS R (OD)
Entity Type:Individual
Prefix:
First Name:CURTISS
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 US HIGHWAY 95A S UNIT A
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-9261
Mailing Address - Country:US
Mailing Address - Phone:775-575-5700
Mailing Address - Fax:775-575-5702
Practice Address - Street 1:415 US HIGHWAY 95A S UNIT A
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-9261
Practice Address - Country:US
Practice Address - Phone:775-575-5700
Practice Address - Fax:775-575-5702
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV19425Medicare UPIN
FL19726ZMedicare ID - Type Unspecified