Provider Demographics
NPI:1336315613
Name:SPENCER D JOHNSON OD PC
Entity Type:Organization
Organization Name:SPENCER D JOHNSON OD PC
Other - Org Name:SOUTH HILLS FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-572-9804
Mailing Address - Street 1:12357 S 450 E
Mailing Address - Street 2:STE 2
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8127
Mailing Address - Country:US
Mailing Address - Phone:801-572-9804
Mailing Address - Fax:801-572-9805
Practice Address - Street 1:12357 S 450 E
Practice Address - Street 2:STE 2
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8127
Practice Address - Country:US
Practice Address - Phone:801-572-9804
Practice Address - Fax:801-572-9805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5937796-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty