Provider Demographics
NPI:1700982410
Name:JOHNSON, JOHN H (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
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 1:156 NO MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478
Mailing Address - Country:US
Mailing Address - Phone:802-524-3933
Mailing Address - Fax:802-524-2023
Practice Address - Street 1:156 NO MAIN ST
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478
Practice Address - Country:US
Practice Address - Phone:802-524-3933
Practice Address - Fax:802-524-2023
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0300000200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8368OtherBCBS
59V013OtherMVP
1345070001OtherDMERCA
VT1000101Medicaid
T25466Medicare UPIN
VTVT9117Medicare ID - Type Unspecified