Provider Demographics
NPI:1831695113
Name:JOHNSON, RICHARD A (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3978 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8363
Mailing Address - Country:US
Mailing Address - Phone:585-394-1128
Mailing Address - Fax:
Practice Address - Street 1:6081 ROUTE 96 STE 8
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-1062
Practice Address - Country:US
Practice Address - Phone:585-924-2550
Practice Address - Fax:585-924-4399
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4221156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician