Provider Demographics
NPI:1356481311
Name:JOHNSON, WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
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 1:30981 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3641
Mailing Address - Country:US
Mailing Address - Phone:734-522-3000
Mailing Address - Fax:734-522-3341
Practice Address - Street 1:30981 5 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3641
Practice Address - Country:US
Practice Address - Phone:734-522-3000
Practice Address - Fax:734-522-3341
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003701152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU85133Medicare UPIN
MIN26930135Medicare PIN