Provider Demographics
NPI:1780012104
Name:ROGER K. JOHNSON, O.D.
Entity Type:Organization
Organization Name:ROGER K. JOHNSON, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-226-0444
Mailing Address - Street 1:1629 UNION AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2134
Mailing Address - Country:US
Mailing Address - Phone:724-226-0444
Mailing Address - Fax:724-226-0744
Practice Address - Street 1:1629 UNION AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2134
Practice Address - Country:US
Practice Address - Phone:724-226-0444
Practice Address - Fax:724-226-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty