Provider Demographics
NPI:1700941556
Name:STEVEN L JOHNSON AN OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:STEVEN L JOHNSON AN OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-448-6046
Mailing Address - Street 1:11401 VALLEY BLVD
Mailing Address - Street 2:103
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3242
Mailing Address - Country:US
Mailing Address - Phone:626-448-6046
Mailing Address - Fax:626-448-7112
Practice Address - Street 1:11401 VALLEY BLVD
Practice Address - Street 2:103
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3242
Practice Address - Country:US
Practice Address - Phone:626-448-6046
Practice Address - Fax:626-448-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5885 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty