Provider Demographics
NPI:1679581581
Name:JOHNSON, STEVEN C (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CALIFORNIA BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-547-2090
Mailing Address - Fax:805-547-2095
Practice Address - Street 1:628 CALIFORNIA BLVD
Practice Address - Street 2:STE C
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-547-2090
Practice Address - Fax:805-547-2095
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38558207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A385580Medicaid
CA00A385580OtherBLUE SHIELD OF CALIFORNIA
A28654Medicare UPIN
CA00A385580Medicaid